Active NPI
John Reed Brundage, PH.D.
- Clinical Psychologist
- Stamford, CT
National Provider Identifier
1417040908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 755
- Practice address
- 144 Morgan Street
Suite 7
Stamford, CT 06905 - Phone
- (203) 325-8411
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 21, 2022
- Sex
- Male
- 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 | 755 | CT | Primary |
Addresses
Primary practice location
144 Morgan Street
Suite 7
Stamford, CT 06905
Mailing address
70 Chambers Road
Danbury, CT 06811
Phone (203) 730-8486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 755 | CT | MD | Clinical Psychologist |
| 000755 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1417040908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 CHAMBERS ROAD",
"city": "DANBURY",
"state": "CT",
"postal_code": "06811",
"telephone_number": "203-730-8486",
"fax_number": "203-730-2219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 MORGAN STREET",
"address_2": "SUITE 7",
"city": "STAMFORD",
"state": "CT",
"postal_code": "06905",
"telephone_number": "203-325-8411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNDAGE",
"first_name": "JOHN",
"middle_name": "REED",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.