MEDICARE: DR. STEPHEN W BUCKLEY PHD

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	013762	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942211255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN W BUCKLEY PHD

Provider Business Mailing Address
First Line	:	1 EXECUTIVE BLVD
Second Line	:	SUITE #109
City	:	MONTEBELLO
State	:	NY
Zip	:	10901-4180
Country	:	US
Telephone Number	:	845-304-5082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 EXECUTIVE BLVD
Second Line	:	SUITE #109
City	:	MONTEBELLO
State	:	NY
Zip	:	10901-4180
Country	:	US
Telephone Number	:	845-304-5082
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	03/31/2008

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Directions to “ DR. STEPHEN W BUCKLEY PHD” Practice Location

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