Healthcare Provider Details

I. General information

NPI: 1013766062
Provider Name (Legal Business Name): AMY BUCKLEY LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MONTAUK HWY
OAKDALE NY
11769-1801
US

IV. Provider business mailing address

26 LUDLOW WAY
OAKDALE NY
11769-2229
US

V. Phone/Fax

Practice location:
  • Phone: 631-942-5733
  • Fax:
Mailing address:
  • Phone: 631-942-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY BUCKLEY
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 631-942-5733