MEDICARE: CASEY BUCENELL BCABA

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	103K00000X	Behavior Analyst	TBD	VA

General Provider Information

NPI Number	:	1972992014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY BUCENELL BCABA

Provider Business Mailing Address
First Line	:	615 NOTTAWAY DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BOWERY ST
Second Line	:	#308
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3756
Country	:	US
Telephone Number	:	757-750-1580
Fax Number	:	757-962-8888

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	10/26/2021

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