MEDICARE: MARIANA KENDALL BULICH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		VA
2	106S00000X	Behavior Technician	RBT-21-157843	VA

General Provider Information

NPI Number	:	1861969537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA KENDALL BULICH

Provider Business Mailing Address
First Line	:	303 SOMERSET AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2604
Country	:	US
Telephone Number	:	804-615-9105
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PARAGON PL
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-1649
Country	:	US
Telephone Number	:	804-562-9997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	12/06/2022

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Directions to “ MARIANA KENDALL BULICH ” Practice Location

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