Healthcare Provider Details

I. General information

NPI: 1679350524
Provider Name (Legal Business Name): HEATHER G BRUNELLI M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WYNDSOR WAY
WARWICK RI
02889
US

IV. Provider business mailing address

11 WYNDSOR WAY
WARWICK RI
02889-3224
US

V. Phone/Fax

Practice location:
  • Phone: 401-742-1978
  • Fax:
Mailing address:
  • Phone: 401-742-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: