Provider Demographics
NPI:1316365877
Name:HATHAWAY, ADELA BUCZYNSKI
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:BUCZYNSKI
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3815
Mailing Address - Country:US
Mailing Address - Phone:407-494-2460
Mailing Address - Fax:
Practice Address - Street 1:338 N PARK AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3815
Practice Address - Country:US
Practice Address - Phone:407-494-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMY 11688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health