Provider Demographics
NPI:1821979329
Name:BRUNKOW, ALEXANDRIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:
Last Name:BRUNKOW
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 1:45 LYME RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1223
Mailing Address - Country:US
Mailing Address - Phone:603-755-6535
Mailing Address - Fax:603-389-9331
Practice Address - Street 1:45 LYME RD STE 300
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1223
Practice Address - Country:US
Practice Address - Phone:603-755-6535
Practice Address - Fax:603-389-9331
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7125103TH0004X
RIPS02375103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth