Healthcare Provider Details

I. General information

NPI: 1639052764
Provider Name (Legal Business Name): ANDREA J BUMBULSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA J HARLEY

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 VAN REED RD STE 102
WYOMISSING PA
19610-1799
US

IV. Provider business mailing address

640 FREEDOM BUSINESS CTR DR STE 220
KING OF PRUSSIA PA
19406-1376
US

V. Phone/Fax

Practice location:
  • Phone: 484-965-9966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-457066
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: