Provider Demographics
NPI:1205363199
Name:BUCKMAN, HOLLY LYNN (MS CLINICAL PSYCHOLO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:MS CLINICAL PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HIGDON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1027
Mailing Address - Country:US
Mailing Address - Phone:219-252-8101
Mailing Address - Fax:
Practice Address - Street 1:1440 BROADWAY STE 314
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2023
Practice Address - Country:US
Practice Address - Phone:888-524-5122
Practice Address - Fax:888-524-5122
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist