Provider Demographics
NPI:1346557055
Name:BUCCO, KRISTINA A (PRINCIPAL COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:BUCCO
Suffix:
Gender:F
Credentials:PRINCIPAL COUNSELOR
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:A
Other - Last Name:LAGASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2 REGENCY PLAZA
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-218-8966
Mailing Address - Fax:
Practice Address - Street 1:2 REGENCY PLAZA
Practice Address - Street 2:SUITE 20
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-218-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKB82305Medicaid