Provider Demographics
NPI:1306813498
Name:BUCCIERE, ROBERT A (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:BUCCIERE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HAMLET AVE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5015
Mailing Address - Country:US
Mailing Address - Phone:801-923-2075
Mailing Address - Fax:
Practice Address - Street 1:510 HAMLET AVE
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-5015
Practice Address - Country:US
Practice Address - Phone:801-923-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4959640-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health