Healthcare Provider Details

I. General information

NPI: 1447345442
Provider Name (Legal Business Name): WENDY EILEEN BUCK LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E PENNSYLVANIA AVE
TOWSON MD
21286-5118
US

IV. Provider business mailing address

9619 HARDING AVE
PARKVILLE MD
21234-2633
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-2222
  • Fax: 410-583-2377
Mailing address:
  • Phone: 410-665-8271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04826
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: