Provider Demographics
NPI:1043109549
Name:BUQUICCHIO, TRESA (MS)
Entity type:Individual
Prefix:
First Name:TRESA
Middle Name:
Last Name:BUQUICCHIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 FLOMICH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-1772
Mailing Address - Country:US
Mailing Address - Phone:386-898-2707
Mailing Address - Fax:
Practice Address - Street 1:386 S ATLANTIC AVE # 208
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-7143
Practice Address - Country:US
Practice Address - Phone:386-258-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health