MEDICARE: MARY BUCCI BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588033468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BUCCI BCABA

Provider Business Mailing Address
First Line	:	3600 CONSHOHOCKEN AVE APT 1607
Second Line	:	APT. 1607
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-5329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 CONSHOHOCKEN AVE APT 1607
Second Line	:	APT. 1607
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-5329
Country	:	US
Telephone Number	:	215-278-9125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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Directions to “ MARY BUCCI BCABA” Practice Location

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