Provider Demographics
NPI:1528019320
Name:BRUCKEN, ROSEMARY (PSYD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BRUCKEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-2147
Mailing Address - Country:US
Mailing Address - Phone:937-657-0019
Mailing Address - Fax:
Practice Address - Street 1:9617 CASTLEROY LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-8366
Practice Address - Country:US
Practice Address - Phone:937-657-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000391396OtherANTHEM BC BS
OH680015634OtherRAILROAD MEDICARE
OH2365748Medicaid
OH$$$$$$$$$002OtherMEDICAL MUTUAL
OH000000391396OtherANTHEM BC BS