Provider Demographics
NPI:1699657353
Name:BRULL, JOHN VALENTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VALENTINE
Last Name:BRULL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2433
Mailing Address - Country:US
Mailing Address - Phone:516-712-5050
Mailing Address - Fax:
Practice Address - Street 1:195 BURTIS AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2433
Practice Address - Country:US
Practice Address - Phone:516-712-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027387103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist