Provider Demographics
NPI:1952479495
Name:BUCCINO, DANIEL L (MSW, LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:L
Last Name:BUCCINO
Suffix:
Gender:M
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2706
Mailing Address - Country:US
Mailing Address - Phone:410-881-5425
Mailing Address - Fax:
Practice Address - Street 1:2900 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2706
Practice Address - Country:US
Practice Address - Phone:410-881-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25129OtherEHP PIN
MDR0260001OtherCFBCBS PIN
MD25299OtherCIGNA BEHAVIORAL PIN
MD25129OtherEHP PIN
MD140QMedicare ID - Type Unspecified