Healthcare Provider Details

I. General information

NPI: 1982885216
Provider Name (Legal Business Name): DEANNA MARIE BUCCI LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 BROADWAY ST
ALDEN NY
14004-9454
US

IV. Provider business mailing address

11901 BROADWAY ST
ALDEN NY
14004-9454
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-3300
  • Fax: 716-937-3304
Mailing address:
  • Phone: 585-813-1017
  • Fax: 716-937-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number082617-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR081390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: