Healthcare Provider Details

I. General information

NPI: 1932003886
Provider Name (Legal Business Name): DALE BUCKMAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PEREGRINE RD
NEWTON MA
02459-3442
US

IV. Provider business mailing address

5 PEREGRINE RD
NEWTON MA
02459-3442
US

V. Phone/Fax

Practice location:
  • Phone: 857-222-4341
  • Fax: 781-205-1890
Mailing address:
  • Phone: 857-222-4341
  • Fax: 781-205-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: DALE BUCKMAN
Title or Position: PROVIDER
Credential: CNP, PMHNP-BC
Phone: 857-222-4341