Provider Demographics
NPI:1760540306
Name:BRUGMAN, JOAN DIANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:DIANE
Last Name:BRUGMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 TATE BLVD SE STE 186
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-449-8563
Mailing Address - Fax:828-323-8348
Practice Address - Street 1:915 TATE BLVD SE STE 186
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-449-8563
Practice Address - Fax:828-323-8348
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2300103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0369QOtherBLUE CROSS BLUE SHIELD ID
NC6000447Medicaid
NC1760540306Medicaid