Provider Demographics
NPI:1720796105
Name:BUCCERI, CASEY (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BUCCERI
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BELMONT AVE APT 2304
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2676
Mailing Address - Country:US
Mailing Address - Phone:973-283-0374
Mailing Address - Fax:
Practice Address - Street 1:920 BELMONT AVE APT 2304
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2676
Practice Address - Country:US
Practice Address - Phone:973-283-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00360900101YA0400X
NJ44SC063915001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)