Provider Demographics
NPI:1487695052
Name:MONTELEONE, BRIAN RONALD (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RONALD
Last Name:MONTELEONE
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 1:1923 J N PEASE PL STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4535
Mailing Address - Country:US
Mailing Address - Phone:704-503-3535
Mailing Address - Fax:704-593-5555
Practice Address - Street 1:1977 J N PEASE PL
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4508
Practice Address - Country:US
Practice Address - Phone:704-503-3535
Practice Address - Fax:704-503-5555
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2846103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2331726Medicare ID - Type Unspecified