Provider Demographics
NPI:1437871126
Name:BUCCIARELLI, AMY (MS,ATR-BC, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:BUCCIARELLI
Suffix:
Gender:F
Credentials:MS,ATR-BC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 3RD ST S # 282
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-201-2122
Mailing Address - Fax:
Practice Address - Street 1:1548 THE GREENS WAY STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2468
Practice Address - Country:US
Practice Address - Phone:904-201-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11552101YM0800X
10-037221700000X
FLMH1152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty