Provider Demographics
NPI:1275694440
Name:BUCKLEY, MAUREEN A (LMHC, LADC-I)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LMHC, LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01227-0194
Mailing Address - Country:US
Mailing Address - Phone:413-684-3455
Mailing Address - Fax:
Practice Address - Street 1:232 1ST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4749
Practice Address - Country:US
Practice Address - Phone:413-442-7474
Practice Address - Fax:413-442-7474
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141101YA0400X
MA5458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1290OtherBLUE CROSS BLUE SHIELD