Provider Demographics
NPI:1982885216
Name:BUCCI, DEANNA MARIE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:BUCCI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9454
Mailing Address - Country:US
Mailing Address - Phone:585-813-1017
Mailing Address - Fax:716-937-3304
Practice Address - Street 1:11901 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9454
Practice Address - Country:US
Practice Address - Phone:716-937-3300
Practice Address - Fax:716-937-3304
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082617-1104100000X
NYR0813901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker