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NPI Code Detail

MEDICARE: JOHN PAUL BRUNELLE PH.D.

MEDICARE: JOHN PAUL BRUNELLE PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistB1-0000738DE
2103T00000XPsychologist4190NC

General Provider Information

NPI Number : 1891027819
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PAUL BRUNELLE PH.D.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-365-6730
Fax Number : 704-365-6731
Provider Business Practice Location Address
First Line : 4741 RANDOLPH RD STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2919
Country : US
Telephone Number : 704-365-6730
Fax Number : 704-365-6731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2010
Last Update Date : 10/18/2022

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Directions to “ JOHN PAUL BRUNELLE PH.D.” Practice Location

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