Healthcare Provider Details

I. General information

NPI: 1629680939
Provider Name (Legal Business Name): BUCKLEY MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MASS MOCA WAY
NORTH ADAMS MA
01247-2446
US

IV. Provider business mailing address

25 COPLEY TER
PITTSFIELD MA
01201-6434
US

V. Phone/Fax

Practice location:
  • Phone: 413-664-4600
  • Fax:
Mailing address:
  • Phone: 413-441-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY M BUCKLEY
Title or Position: PMHNP
Credential: NP
Phone: 413-441-9921