Provider Demographics
NPI:1073535142
Name:EDWARDS-BUCKLEY, ANN E (MS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:EDWARDS-BUCKLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:E
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:7001A EAST PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-875-9904
Mailing Address - Fax:916-875-6970
Practice Address - Street 1:7001A EAST PKWY STE 400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2501
Practice Address - Country:US
Practice Address - Phone:916-875-9904
Practice Address - Fax:916-875-6970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist