Healthcare Provider Details

I. General information

NPI: 1073425450
Provider Name (Legal Business Name): JACQUELYN KRAFT BUCKMAN, LCSW-C LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
TOWSON MD
21204-6819
US

IV. Provider business mailing address

6501 N CHARLES ST
TOWSON MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-4674
  • Fax:
Mailing address:
  • Phone: 410-938-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25311
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: