Active NPI
Constance Ann Brunig, PH.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1336212273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY8162
- Practice address
- 4036 3Rd Ave
San Diego, CA 92103-2102 - Phone
- (619) 296-8103
- Fax
- (619) 296-5027
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY8162 | CA | Primary |
Addresses
Primary practice location
4036 3Rd Ave
San Diego, CA 92103-2102
Mailing address
4036 3Rd Ave
San Diego, CA 92103-2102
Phone (619) 296-8103
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11331265 | Other | CA | CAQH ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 5, 2023 through Sep 5, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY8162 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184889600000",
"number": "1336212273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4036 3RD AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032102",
"telephone_number": "619-296-8103",
"fax_number": "619-296-5027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4036 3RD AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032102",
"telephone_number": "619-296-8103",
"fax_number": "619-296-5027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNIG",
"first_name": "CONSTANCE",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-16",
"last_updated": "2007-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY8162",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH ID",
"identifier": "11331265",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.