Michele Brenneman, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY9335 Issued in FL

Practice address

460 Town Plaza Ave
Suite 230
Ponte Vedra, FL 32081-5139

Phone

(904) 671-6237

NPI assigned

Jun 14, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1922458686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 TOWN PLAZA AVE",
            "address_2": "SUITE 230",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815139",
            "telephone_number": "904-671-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 TOWN PLAZA AVE",
            "address_2": "SUITE 230",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815139",
            "telephone_number": "904-671-6237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNEMAN",
        "first_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY9335",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "003326",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Borgio, ATC
• William David Boyd, M.D.
• Melanie Loretta Bradley, DO
• Meredith Johnston Brazell, D.O.
• Julie Bredt, ARNP-FNP
• Jeffrey Joseph Brimmer, D.P.M.
• Josephine Elizabeth Brooke, APRN
• Renee Brooke, CCC-SLP
• Ashley Brooks, MD
• James Michael Broome

• Psychologist in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.