Provider Demographics
NPI:1801955547
Name:BRUSINI, JEFFREY R (DBH, ESQ)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:BRUSINI
Suffix:
Gender:M
Credentials:DBH, ESQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEUROBEHAVIORAL CONSULTANTS, LLC
Mailing Address - Street 2:2893 POST RD
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-831-6277
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH RD A-23
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-831-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01761103G00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJB00075Medicaid
11549500OtherCAQH