Healthcare Provider Details

I. General information

NPI: 1912057514
Provider Name (Legal Business Name): SARA LYNN BUCKNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HIGH ST
NASHUA NH
03060-3312
US

IV. Provider business mailing address

77 NORTHEASTERN BLVD
NASHUA NH
03062-3161
US

V. Phone/Fax

Practice location:
  • Phone: 603-821-7788
  • Fax: 603-821-5620
Mailing address:
  • Phone: 603-882-3616
  • Fax: 603-595-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1024
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: