Healthcare Provider Details

I. General information

NPI: 1699941146
Provider Name (Legal Business Name): BRUCE DAVID RYBARCZYK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9935 REVOLUTIONARY PL
MECHANICSVILLE VA
23116-6620
US

IV. Provider business mailing address

9935 REVOLUTIONARY PL
MECHANICSVILLE VA
23116-6620
US

V. Phone/Fax

Practice location:
  • Phone: 804-514-9172
  • Fax: 804-828-2237
Mailing address:
  • Phone: 804-514-9172
  • Fax: 804-828-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: