Provider Demographics
NPI:1316222441
Name:BUCKLEY, BETH E (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:E
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MS, CCC/SLP
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 8
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0008
Mailing Address - Country:US
Mailing Address - Phone:845-477-2411
Mailing Address - Fax:
Practice Address - Street 1:1247 LAKES RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4221
Practice Address - Country:US
Practice Address - Phone:845-477-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014677-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01455325Medicaid