=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598060717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ANNE ELIZABETH BUCKLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2011
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 REPUBLIC AVE
-----------------------------------------------------
City | TOPSHAM
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04086-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-449-1415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 PROSPECT ST
-----------------------------------------------------
City | GARDINER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04345-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-485-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | MC12869
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------