Jeffrey R. Brusini, D.BH., ESQ.
Individual provider Active NPI Clinical Child & Adolescent Psychologist · Peace Dale, RI
NPI 1801955547 · NPPES record last updated Mar 31, 2022
Key facts
- NPI
- 1801955547
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Child & Adolescent Psychologist 103TC2200X
- License
- PS01761 (RI)
- Practice address
- 23 North Rd a-23
Peace Dale, RI 02879 - Phone
- (401) 831-6277
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS01761 | RI | MD | Clinical Child & Adolescent Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS01761 | RI | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PS01761 | RI | Yes |
Addresses
Primary practice location
23 North Rd a-23
Peace Dale, RI 02879
Mailing address
Neurobehavioral Consultants, LLC
2893 Post Rd
Warwick, RI 02886
Phone (401) 831-6277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JB00075 | Medicaid | RI | |
| 11549500 | Other | CAQH |
Other providers in Peace Dale, RI
- 981 Kings Town Road Operating Company, LLC
- Cara Berman
- Broadrock Road Group Home
- Efrem Bromberg
- Colleen Carpender
- Samantha R Crowley
- Lindsey Crowninshield
- Cultivating Minds Counseling Services
- Amanda L Fontaine
All providers in Peace Dale, RI · Clinical Child & Adolescent Psychologist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.