Healthcare Provider Details

I. General information

NPI: 1205363199
Provider Name (Legal Business Name): HOLLY LYNN BUCKMAN MS CLINICAL PSYCHOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BROADWAY STE 314
OAKLAND CA
94612-2023
US

IV. Provider business mailing address

179 HIGDON AVE APT 3
MOUNTAIN VIEW CA
94041-1027
US

V. Phone/Fax

Practice location:
  • Phone: 888-524-5122
  • Fax: 888-524-5122
Mailing address:
  • Phone: 219-252-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: