Provider Demographics
NPI:1093715526
Name:BUKANC, MICHAEL (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BUKANC
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 PEARL ST
Mailing Address - Street 2:STE 10
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8564
Mailing Address - Country:US
Mailing Address - Phone:802-658-5300
Mailing Address - Fax:802-658-2067
Practice Address - Street 1:267 PEARL ST
Practice Address - Street 2:STE 10
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8564
Practice Address - Country:US
Practice Address - Phone:802-658-5300
Practice Address - Fax:802-658-2067
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical