Provider Demographics
NPI:1376707240
Name:BUCCIGROSS, JAMES MITCHELL (PHD, DABPS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MITCHELL
Last Name:BUCCIGROSS
Suffix:
Gender:M
Credentials:PHD, DABPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 BELDEN VILLAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2552
Mailing Address - Country:US
Mailing Address - Phone:330-606-6119
Mailing Address - Fax:
Practice Address - Street 1:4450 BELDEN VILLAGE ST NW STE 211
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2596
Practice Address - Country:US
Practice Address - Phone:330-606-6119
Practice Address - Fax:330-238-1609
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4859103G00000X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic