Healthcare Provider Details

I. General information

NPI: 1992108930
Provider Name (Legal Business Name): JOAN THERESA BUCKLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2014
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 HIGHWAY 33 STE 505
TRENTON NJ
08690-1750
US

IV. Provider business mailing address

PO BOX 830826
PHILADELPHIA PA
19182-0826
US

V. Phone/Fax

Practice location:
  • Phone: 609-890-1050
  • Fax: 609-890-0950
Mailing address:
  • Phone: 609-890-1050
  • Fax: 609-890-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05426900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: