Provider Demographics
NPI:1447584735
Name:BRUNETTI, DAVID GENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GENE
Last Name:BRUNETTI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21308 JOHN MILLESS DR
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4708
Mailing Address - Country:US
Mailing Address - Phone:763-428-4060
Mailing Address - Fax:763-428-1711
Practice Address - Street 1:21308 JOHN MILLESS DR
Practice Address - Street 2:SUITE 101B
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4708
Practice Address - Country:US
Practice Address - Phone:763-428-4060
Practice Address - Fax:763-428-1711
Is Sole Proprietor?:No
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical