Healthcare Provider Details

I. General information

NPI: 1396777314
Provider Name (Legal Business Name): SUZANNE WINKELMAN BRUNELLE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SARATOGA RD SOCHA PLAZA SOUTH
GLENVILLE NY
12302-7100
US

IV. Provider business mailing address

4 WOODS EDGE
BURNT HILLS NY
12027-9796
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-3220
  • Fax: 518-399-7195
Mailing address:
  • Phone: 518-399-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: