MEDICARE: ROSEMARY BRUCKEN PSY.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	5657	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	680015634	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000391396	OTHER	OH	ANTHEM BC BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528019320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY BRUCKEN PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75030-2147
Country	:	US
Telephone Number	:	937-657-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	9617 CASTLEROY LN
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75089-8366
Country	:	US
Telephone Number	:	937-657-0019
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/18/2014

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