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General NPI Number Information
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NPI Number | 1205499324
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Entity Type | Organization
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Legal Business Name | BRIDGETT BUCKERY LCSW PLLC
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 19011 119TH AVE STE A
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3324
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Country | US
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Telephone | 718-415-0871
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Fax |
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Provider Business Mailing Address
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Address Line | 19011 119TH AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3324
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Country | US
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Telephone | 718-415-0871
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Fax |
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Authorized Official
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Title or Position | PRESIDENT , CEO
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Name | MRS. BRIDGETT BUCKERY
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Credential | LCSWR
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Telephone | 718-415-0871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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