MEDICARE: ROBERT A BUCCIERE LCSW

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	101YM0800X	Mental Health Counselor	4959640-3501	UT

General Provider Information

NPI Number	:	1306813498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A BUCCIERE LCSW

Provider Business Mailing Address
First Line	:	510 HAMLET AVE
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-5015
Country	:	US
Telephone Number	:	801-923-2075
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 HAMLET AVE
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-5015
Country	:	US
Telephone Number	:	801-923-2075
Fax Number	:

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	06/14/2014

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