Healthcare Provider Details

I. General information

NPI: 1972845741
Provider Name (Legal Business Name): HEATHER M BRUSCHWEIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER M AMBROSON PSYD

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903-3363
US

IV. Provider business mailing address

PO BOX 749112 PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5314
  • Fax: 434-924-0185
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005788
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810005214
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: