Provider Demographics
NPI:1295818011
Name:BUCKLEY, LAUREN O'BRIEN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:O'BRIEN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5132
Mailing Address - Country:US
Mailing Address - Phone:215-279-3932
Mailing Address - Fax:
Practice Address - Street 1:1153 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5132
Practice Address - Country:US
Practice Address - Phone:215-279-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO-000520171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist