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General NPI Number Information
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NPI Number | 1730354804
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Entity Type | Organization
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Legal Business Name | BUCZEK & EHRMANTRAUT PC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1241 MALL DR
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City | RICHMOND
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State | VA
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Zip | 23235-4879
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Country | US
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Telephone | 804-794-5928
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Fax | 804-379-6385
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Provider Business Mailing Address
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Address Line | 1241 MALL DR
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City | RICHMOND
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State | VA
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Zip | 23235-4879
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Country | US
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Telephone | 804-794-5928
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Fax | 804-379-6385
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Authorized Official
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Title or Position | SENIOR PARTNER
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Name | DR. TERESA ANNE BUCZEK
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Credential | PH.D.
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Telephone | 804-794-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001121
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License Number State | VA
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