Provider Demographics
NPI:1295786390
Name:BUCZEK, TERESA ANN (PH,D)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:BUCZEK
Suffix:
Gender:F
Credentials:PH,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 MALL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4737
Mailing Address - Country:US
Mailing Address - Phone:804-794-5928
Mailing Address - Fax:804-379-6385
Practice Address - Street 1:1241 MALL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4737
Practice Address - Country:US
Practice Address - Phone:804-794-5928
Practice Address - Fax:804-379-6385
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical