MEDICARE: MS. MARY E BUCKLEY LICSW

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	1041C0700X	Clinical Social Worker	ISW00048	RI
2	1041C0700X	Clinical Social Worker	107188	MA
3	1041C0700X	Clinical Social Worker	007069	CT

General Provider Information

NPI Number	:	1457437600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY E BUCKLEY LICSW

Provider Business Mailing Address
First Line	:	397 THOMPSON RD
Second Line	:
City	:	THOMPSON
State	:	CT
Zip	:	06277-2215
Country	:	US
Telephone Number	:	401-465-3388
Fax Number	:	860-315-5055

Provider Business Practice Location Address
First Line	:	390 TOLL GATE RD STE 206
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4351
Country	:	US
Telephone Number	:	401-465-3388
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	04/01/2026

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Directions to “ MS. MARY E BUCKLEY LICSW” Practice Location

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