Healthcare Provider Details

I. General information

NPI: 1255627741
Provider Name (Legal Business Name): NICOLE BUENO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 THE ALAMEDA STE 207
SAN JOSE CA
95126-2223
US

IV. Provider business mailing address

1625 THE ALAMEDA STE 207
SAN JOSE CA
95126-2223
US

V. Phone/Fax

Practice location:
  • Phone: 408-724-1009
  • Fax:
Mailing address:
  • Phone: 408-724-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 23339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: