MEDICARE: MS. ANNE MARIE THERESA BUCK M.S.

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	103T00000X	Psychologist	PS5005750L	PA

General Provider Information

NPI Number	:	1831403062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE MARIE THERESA BUCK M.S.

Provider Business Mailing Address
First Line	:	1532 NAUDAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1627
Country	:	US
Telephone Number	:	215-732-3289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 NAUDAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1627
Country	:	US
Telephone Number	:	215-732-3289
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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