Healthcare Provider Details

I. General information

NPI: 1558500868
Provider Name (Legal Business Name): ADRIENNE RENEE BUKOVSKY LMT, NCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PINE GROVE COMMONS
YORK PA
17403-5151
US

IV. Provider business mailing address

209 SEPTEMBER WAY
YORK PA
17403-4789
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-5590
  • Fax:
Mailing address:
  • Phone: 443-983-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM03246
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: