MEDICARE: DR. BRIAN RONALD MONTELEONE 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
1	103TC1900X	Counseling Psychologist	2846	NC

General Provider Information

NPI Number	:	1487695052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN RONALD MONTELEONE PH.D.

Provider Business Mailing Address
First Line	:	1923 J N PEASE PL STE 204
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4535
Country	:	US
Telephone Number	:	704-503-3535
Fax Number	:	704-593-5555

Provider Business Practice Location Address
First Line	:	1977 J N PEASE PL
Second Line	:	SUITE 104
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4508
Country	:	US
Telephone Number	:	704-503-3535
Fax Number	:	704-503-5555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/22/2022

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