Provider Demographics
NPI:1568876803
Name:BUCCIERE, VICKI (LMSW, ACSW, SAP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:BUCCIERE
Suffix:
Gender:F
Credentials:LMSW, ACSW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44511 BROADMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8633
Mailing Address - Country:US
Mailing Address - Phone:248-880-8684
Mailing Address - Fax:734-738-6980
Practice Address - Street 1:149 NORTH CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1486
Practice Address - Country:US
Practice Address - Phone:248-880-8684
Practice Address - Fax:734-738-6980
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010183461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical