Provider Demographics
NPI:1720796105
Name:BUCCERI, CASEY (LCADC, LSW)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BUCCERI
Suffix:
Gender:M
Credentials:LCADC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CENTER GROVE RD APT F-21
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4472
Mailing Address - Country:US
Mailing Address - Phone:973-944-1222
Mailing Address - Fax:
Practice Address - Street 1:44 CENTER GROVE RD APT F-21
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4472
Practice Address - Country:US
Practice Address - Phone:862-283-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00360900101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)