Provider Demographics
NPI:1275195109
Name:BUCKLEY, ALEXANDRIA SIMONE (MSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:SIMONE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W MARQUETTE RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1817
Mailing Address - Country:US
Mailing Address - Phone:773-349-8031
Mailing Address - Fax:
Practice Address - Street 1:2601 W MARQUETTE RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1817
Practice Address - Country:US
Practice Address - Phone:773-349-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder