MEDICARE: DR. TERESA ANN BUCZEK PH,D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810001121	VA

General Provider Information

NPI Number	:	1295786390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA ANN BUCZEK PH,D.

Provider Business Mailing Address
First Line	:	1241 MALL DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-4737
Country	:	US
Telephone Number	:	804-794-5928
Fax Number	:	804-379-6385

Provider Business Practice Location Address
First Line	:	1241 MALL DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-4737
Country	:	US
Telephone Number	:	804-794-5928
Fax Number	:	804-379-6385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	06/23/2010

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