Provider Demographics
NPI:1265043525
Name:BUCCI, STACEY (LICSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BUCCI
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 1:27 MANITOU RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3518
Mailing Address - Country:US
Mailing Address - Phone:781-223-3400
Mailing Address - Fax:
Practice Address - Street 1:27 MANITOU RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3518
Practice Address - Country:US
Practice Address - Phone:781-223-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1031566104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker