Healthcare Provider Details

I. General information

NPI: 1821979329
Provider Name (Legal Business Name): ALEXANDRIA BRUNKOW PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 10/24/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LYME RD STE 300
HANOVER NH
03755-1223
US

IV. Provider business mailing address

45 LYME RD STE 300
HANOVER NH
03755-1223
US

V. Phone/Fax

Practice location:
  • Phone: 603-755-6535
  • Fax: 603-389-9331
Mailing address:
  • Phone: 603-755-6535
  • Fax: 603-389-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number7125
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPS02375
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: