Provider Demographics
NPI:1922705839
Name:BUCENEC, DYLAN TAYLOR (LSW)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:TAYLOR
Last Name:BUCENEC
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-9779
Mailing Address - Country:US
Mailing Address - Phone:862-354-0192
Mailing Address - Fax:
Practice Address - Street 1:77 SHADY LN
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-9779
Practice Address - Country:US
Practice Address - Phone:862-354-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06871700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker