Provider Demographics
NPI:1669033221
Name:BUCCIERO, CHRISTIN ANN
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:ANN
Last Name:BUCCIERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ALEXANDER CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2115
Mailing Address - Country:US
Mailing Address - Phone:856-905-0032
Mailing Address - Fax:
Practice Address - Street 1:300 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9556
Practice Address - Country:US
Practice Address - Phone:568-905-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist