MEDICARE: DR. CYNDIE MARIE BUCKSON PSY.D.

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	103TC0700X	Clinical Psychologist	04117	MD
2	103TF0200X	Forensic Psychologist	04117	MA

General Provider Information

NPI Number	:	1528213287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNDIE MARIE BUCKSON PSY.D.

Provider Business Mailing Address
First Line	:	5200 ROBERTS PROSPECT DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-3378
Country	:	US
Telephone Number	:	301-806-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 ROBERTS PROSPECT DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-3378
Country	:	US
Telephone Number	:	301-806-1860
Fax Number	:

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

Provider Enumeration Date	:	11/22/2008
Last Update Date	:	11/22/2008

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