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General NPI Number Information
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NPI Number | 1992277149
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Entity Type | Individual
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Provider Name | KATHERINE BRUCKNER MED, LBA
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Gender | Female
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 8401 MAYLAND DR STE 5275
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City | RICHMOND
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 434-207-6422
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 GOLF PARK DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-1008
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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 | 0133001085
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License Number State | VA
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