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General NPI Number Information
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NPI Number | 1245578376
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Entity Type | Organization
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Legal Business Name | ELIZABETH J. BUCKLEY, PH.D. PA
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 98 RIVERSIDE DRIVE SUITE C
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City | NEW YORK
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State | NY
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Zip | 10024-5323
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Country | US
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Telephone | 352-665-9664
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Fax | 855-601-9484
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Provider Business Mailing Address
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Address Line | 98 RIVERSIDE DRIVE SUITE C
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City | NEW YORK
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State | NY
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Zip | 10024-5323
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Country | US
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Telephone | 352-665-9664
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Fax | 855-601-9484
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Authorized Official
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Title or Position | OWNER-PSYCHOLOGIST
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Name | DR. ELIZABETH J. BUCKLEY
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Credential | PH.D.
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Telephone | 352-665-9664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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