Healthcare Provider Details

I. General information

NPI: 1265276570
Provider Name (Legal Business Name): CAITLIN MICHELLE OGRAM BUCKLEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN MICHELLE OGRAM

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 PLAINSBORO RD STE 2000C
PLAINSBORO NJ
08536-3048
US

IV. Provider business mailing address

3213 FOX RUN DR
PLAINSBORO NJ
08536-2723
US

V. Phone/Fax

Practice location:
  • Phone: 856-616-6433
  • Fax:
Mailing address:
  • Phone: 610-574-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS02259
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: