Provider Demographics
NPI:1326792706
Name:BUCKLEY-HAMM, MARY SUSAN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:BUCKLEY-HAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-8925
Mailing Address - Country:US
Mailing Address - Phone:610-413-2357
Mailing Address - Fax:
Practice Address - Street 1:1120 HOBART AVE STE C
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2028
Practice Address - Country:US
Practice Address - Phone:610-371-8035
Practice Address - Fax:610-685-2679
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139028104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker