Provider Demographics
NPI:1154654390
Name:BRUMBAUGH, MARCIA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:L
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:L
Other - Last Name:CARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1009 KELLIE CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5544
Mailing Address - Country:US
Mailing Address - Phone:978-758-1144
Mailing Address - Fax:
Practice Address - Street 1:2415 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-3337
Practice Address - Country:US
Practice Address - Phone:252-208-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005329103TC0700X
NC4482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical