Niccole K Brusa, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071009162 Issued in IL

Practice address

121 Fairfield Way
Suite 240
Bloomingdale, IL 60108-1588

Phone

(630) 309-2989

NPI assigned

Feb 4, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Amer & Associates SC

  • Psychiatry Physician
  • Bloomingdale, IL
  • NPI 1366507071
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1336507342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 FAIRFIELD WAY",
            "address_2": "SUITE 240",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081588",
            "telephone_number": "630-309-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 FAIRFIELD WAY",
            "address_2": "SUITE 240",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081588",
            "telephone_number": "630-309-2989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSA",
        "first_name": "NICCOLE",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnathan Brenner, MA, ED.S.
• Abigail Brier, D.M.D
• Bright Shen Acupuncture
• Benjamin Brown
• Michael Bruno, PHARMD
• Dwayne Bernard Buchanan, M.D.
• Maria Budzynski, P.T.
• Marija J. Bulatovic, DNP, MSN
• Elizabeth Nancy Bulow, LCPC
• Courtney Burland, PA-C

• Clinical Psychologist in Bloomingdale, IL
• Providers in Bloomingdale, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.