Provider Demographics
NPI:1114512142
Name:BUCKNEY, COURTNEY (MHC-LP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BUCKNEY
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 5TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7608
Mailing Address - Country:US
Mailing Address - Phone:315-284-0270
Mailing Address - Fax:
Practice Address - Street 1:246 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7608
Practice Address - Country:US
Practice Address - Phone:315-284-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP108500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP108500OtherNEW YORK STATE LICENSURE BOARD