Provider Demographics
NPI:1275807786
Name:BRUGMAN BEHAVIORAL CARE, PLLC
Entity Type:Organization
Organization Name:BRUGMAN BEHAVIORAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-869-8878
Mailing Address - Street 1:2907 ROUSSEAU CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2103
Mailing Address - Country:US
Mailing Address - Phone:704-869-8878
Mailing Address - Fax:704-869-8879
Practice Address - Street 1:2907 ROUSSEAU CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2103
Practice Address - Country:US
Practice Address - Phone:704-869-8878
Practice Address - Fax:704-869-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008191Medicaid