Individual
MICHAELA MARIE BUCCHIANERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D, LP
Contact information
Practice address
12301 WHITEWATER DR STE 101, MINNETONKA, MN 55343-4157
(952) 999-6097
(952) 426-0508
Mailing address
12301 WHITEWATER DR STE 101, MINNETONKA, MN 55343-4157
(952) 999-6097
(952) 426-0508
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6153
MN
103TC2200X
Clinical Child & Adolescent Psychologist
LP6153
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255840187
—
MN
Enumeration date
09/22/2017
Last updated
11/20/2017
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