Provider Demographics
NPI:1841724234
Name:BRUNELLE, LISA MARIE (PHD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5447
Mailing Address - Country:US
Mailing Address - Phone:805-479-7682
Mailing Address - Fax:
Practice Address - Street 1:22231 MULHOLLAND HWY STE 106
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5178
Practice Address - Country:US
Practice Address - Phone:818-222-9300
Practice Address - Fax:818-223-8224
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical