Provider Demographics
NPI:1386010783
Name:BUCKWASH, JENNIFER MISUNAS (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MISUNAS
Last Name:BUCKWASH
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:YATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3778
Mailing Address - Country:US
Mailing Address - Phone:570-574-4368
Mailing Address - Fax:
Practice Address - Street 1:400 3RD AVE STE 218
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5816
Practice Address - Country:US
Practice Address - Phone:570-574-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional