Provider Demographics
NPI:1396024170
Name:BUSCAGLIA, JOHN P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:BUSCAGLIA
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 1:67 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2528
Mailing Address - Country:US
Mailing Address - Phone:973-783-1286
Mailing Address - Fax:
Practice Address - Street 1:67 CLUB RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2528
Practice Address - Country:US
Practice Address - Phone:973-783-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054580001041C0700X
NYR029792-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR029792-1OtherLICENSED CLINICAL SOCIAL WORKER
NJ44SC05458000OtherLICENSED CLINICAL SOCIAL WORKER