Provider Demographics
NPI:1134316698
Name:BUCK, SARA G (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:G
Last Name:BUCK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:GAIL
Other - Middle Name:M
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-0222
Mailing Address - Country:US
Mailing Address - Phone:410-667-0460
Mailing Address - Fax:410-628-7611
Practice Address - Street 1:10704 CARDINGTON WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3075
Practice Address - Country:US
Practice Address - Phone:410-667-0460
Practice Address - Fax:410-628-7611
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD056671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD328RMedicare PIN