Provider Demographics
NPI:1407961808
Name:BUCKERY, BRIDGETT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRIDGETT
Middle Name:
Last Name:BUCKERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:BRIDGETT
Other - Middle Name:
Other - Last Name:BUCKERY-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:19011 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3324
Mailing Address - Country:US
Mailing Address - Phone:718-341-8751
Mailing Address - Fax:718-341-8751
Practice Address - Street 1:190-11 119TH AVENUE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3324
Practice Address - Country:US
Practice Address - Phone:718-341-8751
Practice Address - Fax:718-341-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052487-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker