Healthcare Provider Details

I. General information

NPI: 1114856853
Provider Name (Legal Business Name): CARRIE ELIZABETH BUCKWALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 BRODHEAD RD
MONACA PA
15061-3132
US

IV. Provider business mailing address

3105 VENTANA DR
CORAOPOLIS PA
15108-9434
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-6670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: