MEDICARE: MS. AMY BUCCIARELLI MS,ATR-BC, LMHC, NCC

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	MH11552	FL
2	221700000X	Art Therapist	10-037
3	101YM0800X	Mental Health Counselor	MH1152	FL

General Provider Information

NPI Number	:	1437871126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY BUCCIARELLI MS,ATR-BC, LMHC, NCC

Provider Business Mailing Address
First Line	:	3948 3RD ST S # 282
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	904-201-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1548 THE GREENS WAY STE 4
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2468
Country	:	US
Telephone Number	:	904-201-2122
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	10/31/2022

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