MEDICARE: DR. BLAIR MICHELE BUCKMAN 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578924361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR MICHELE BUCKMAN PSY.D.

Provider Business Mailing Address
First Line	:	400 VILLAGE SQUARE XING STE 2B
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3227
Country	:	US
Telephone Number	:	561-676-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VILLAGE SQUARE XING STE 2B
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3227
Country	:	US
Telephone Number	:	561-676-5755
Fax Number	:

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

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	07/16/2020

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