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General NPI Number Information
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NPI Number | 1568876803
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Entity Type | Individual
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Provider Name | VICKI BUCCIERE LMSW, ACSW, SAP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2014
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Last Update Date | 06/15/2014
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Provider Practice Location Address
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Address Line | 149 NORTH CTR SUITE 200
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City | NORTHVILLE
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State | MI
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Zip | 48167-1486
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Country | US
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Telephone | 248-880-8684
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Fax | 734-738-6980
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Provider Business Mailing Address
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Address Line | 44511 BROADMOOR BLVD
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City | NORTHVILLE
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State | MI
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Zip | 48168-8633
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Country | US
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Telephone | 248-880-8684
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Fax | 734-738-6980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801018346
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License Number State | MI
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