Provider Demographics
NPI:1154636363
Name:BUCK, DOROTHY CECELIA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:CECELIA
Last Name:BUCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ELM ST
Mailing Address - Street 2:C6
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3150
Mailing Address - Country:US
Mailing Address - Phone:781-395-4391
Mailing Address - Fax:
Practice Address - Street 1:175 ELM ST
Practice Address - Street 2:C6
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-3150
Practice Address - Country:US
Practice Address - Phone:781-395-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health