Provider Demographics
NPI:1558500868
Name:BUKOVSKY, ADRIENNE RENEE (LMT, NCMT)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:RENEE
Last Name:BUKOVSKY
Suffix:
Gender:F
Credentials:LMT, NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SEPTEMBER WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4789
Mailing Address - Country:US
Mailing Address - Phone:443-983-1205
Mailing Address - Fax:
Practice Address - Street 1:140 PINE GROVE COMMONS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5151
Practice Address - Country:US
Practice Address - Phone:717-851-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist