Provider Demographics
NPI:1417189606
Name:BUCK, AMY WYETH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:WYETH
Last Name:BUCK
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 1:14 BUCKS LN
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-6270
Mailing Address - Country:US
Mailing Address - Phone:207-582-1278
Mailing Address - Fax:
Practice Address - Street 1:14 BUCKS LN
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-6270
Practice Address - Country:US
Practice Address - Phone:207-582-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child