Healthcare Provider Details

I. General information

NPI: 1487695052
Provider Name (Legal Business Name): BRIAN RONALD MONTELEONE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 J N PEASE PL SUITE 104
CHARLOTTE NC
28262-4508
US

IV. Provider business mailing address

1923 J N PEASE PL STE 204
CHARLOTTE NC
28262-4535
US

V. Phone/Fax

Practice location:
  • Phone: 704-503-3535
  • Fax: 704-503-5555
Mailing address:
  • Phone: 704-503-3535
  • Fax: 704-593-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2846
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: