MEDICARE: BUCKERY-SMITH CONSULTING SERVICES,LLC

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	104100000X	Social Worker	R0524871	NY

General Provider Information

NPI Number	:	1821393398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKERY-SMITH CONSULTING SERVICES,LLC

Provider Business Mailing Address
First Line	:	19011 119TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3324
Country	:	US
Telephone Number	:	718-341-8751
Fax Number	:

Provider Business Practice Location Address
First Line	:	19011 119TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3324
Country	:	US
Telephone Number	:	718-341-8751
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. BRIDGETT BUCKERY
Credential	:	LCSW
Telephone Number	:	718-415-0871

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	01/14/2011

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