Healthcare Provider Details

I. General information

NPI: 1942367875
Provider Name (Legal Business Name): NANCY JEANNE BUCKWALTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MARCHWOOD RD SUITE 1-E
EXTON PA
19341-1835
US

IV. Provider business mailing address

6 COLTS MEADOW DR
DOWNINGTOWN PA
19335-1886
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-9060
  • Fax:
Mailing address:
  • Phone: 484-888-1310
  • Fax: 267-238-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015113
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier11547138
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: