Michaela Marie Bucchianeri, PH.D, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP6153 Issued in MN

Practice address

12301 Whitewater Dr Ste 101
Minnetonka, MN 55343-4157

Phone

(952) 999-6097

Fax

(952) 426-0508

NPI assigned

Sep 22, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511136000000",
    "number": "1255840187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 WHITEWATER DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434157",
            "telephone_number": "952-999-6097",
            "fax_number": "952-426-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 WHITEWATER DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434157",
            "telephone_number": "952-999-6097",
            "fax_number": "952-426-0508"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12301 Whitewater Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553434157",
            "country_code": "US",
            "telephone_number": "952-999-6097",
            "fax_number": "952-426-0508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCCHIANERI",
        "first_name": "MICHAELA",
        "middle_name": "MARIE",
        "credential": "PH.D, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-22",
        "last_updated": "2017-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP6153",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255840187",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Bruestle
• Lauren Rachel Brull
• Charlene Marie Brush, ARNP
• Anne K Brutlag, MD
• Sara Marie Bryan, PT
• Kaitlin Buckelew
• Kathryn Jo Buechler
• Karla Buerkle, PH.D.
• Vanessa Bullinger, LADC
• Jonathan Weiss Bundt, LMFT

• Clinical Psychologist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.