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General NPI Number Information
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NPI Number | 1972992014
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Entity Type | Individual
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Provider Name | CASEY BUCENELL BCABA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 120 BOWERY ST #308
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3756
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Country | US
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Telephone | 757-750-1580
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Fax | 757-962-8888
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Provider Business Mailing Address
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Address Line | 615 NOTTAWAY DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | TBD
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License Number State | VA
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