Provider Demographics
NPI:1972992014
Name:BUCENELL, CASEY (BCABA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BUCENELL
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NOTTAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 BOWERY ST
Practice Address - Street 2:#308
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3756
Practice Address - Country:US
Practice Address - Phone:757-750-1580
Practice Address - Fax:757-962-8888
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VATBD103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst