Provider Demographics
NPI:1750192746
Name:BRUNELLI, ELIZABETH MJ
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MJ
Last Name:BRUNELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SUNSET AVE APT 48B
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3793
Mailing Address - Country:US
Mailing Address - Phone:401-692-0681
Mailing Address - Fax:
Practice Address - Street 1:415 SUNSET AVE APT 48B
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3793
Practice Address - Country:US
Practice Address - Phone:401-692-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI106S00000X106S00000X
106S00000X
106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician