Provider Demographics
NPI:1629245501
Name:BRUFFEY, MATTHEW VERNON (PSYD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:VERNON
Last Name:BRUFFEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W PICCADILLY ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3916
Mailing Address - Country:US
Mailing Address - Phone:540-667-1389
Mailing Address - Fax:540-667-1394
Practice Address - Street 1:134 W PICCADILLY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3916
Practice Address - Country:US
Practice Address - Phone:540-667-1389
Practice Address - Fax:540-667-1394
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical