Provider Demographics
NPI:1861969537
Name:BULICH, MARIANA KENDALL
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:KENDALL
Last Name:BULICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:KENDALL
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2604
Mailing Address - Country:US
Mailing Address - Phone:804-615-9105
Mailing Address - Fax:
Practice Address - Street 1:6800 PARAGON PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1649
Practice Address - Country:US
Practice Address - Phone:804-562-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
VARBT-21-157843106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst