MEDICARE: MS. SARA BUCKLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205060639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA BUCKLEY LCSW

Provider Business Mailing Address
First Line	:	7112 WHISPERING WINDS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5244
Country	:	US
Telephone Number	:	512-298-8064
Fax Number	:	512-697-8279

Provider Business Practice Location Address
First Line	:	8700 MANCHACA RD
Second Line	:	STE 801
City	:	AUSTIN
State	:	TX
Zip	:	78748-5379
Country	:	US
Telephone Number	:	512-298-8064
Fax Number	:	512-697-8279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/11/2017

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