Provider Demographics
NPI:1093492746
Name:BUCKLEY, MICHAELA EILLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:EILLEEN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 MAEDER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2044
Mailing Address - Country:US
Mailing Address - Phone:516-589-4399
Mailing Address - Fax:
Practice Address - Street 1:1457 MAEDER AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2044
Practice Address - Country:US
Practice Address - Phone:516-589-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025268103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist