Provider Demographics
NPI:1972845741
Name:BRUSCHWEIN, HEATHER M (PSYD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:BRUSCHWEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:AMBROSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 JEFFERSON PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3363
Practice Address - Country:US
Practice Address - Phone:434-924-5314
Practice Address - Fax:434-924-0185
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
VA0810005788103TC0700X
VA0810005214103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical