Provider Demographics
NPI:1225755721
Name:BUKURAS, STACEY KARCHER (LICSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:KARCHER
Last Name:BUKURAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1327
Mailing Address - Country:US
Mailing Address - Phone:617-306-2912
Mailing Address - Fax:
Practice Address - Street 1:586 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1327
Practice Address - Country:US
Practice Address - Phone:617-306-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1253281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical