Provider Demographics
NPI:1437187309
Name:BUCKLER, RONNI (LCSW)
Entity Type:Individual
Prefix:
First Name:RONNI
Middle Name:
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BROAD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1052
Mailing Address - Country:US
Mailing Address - Phone:410-641-4598
Mailing Address - Fax:410-641-4696
Practice Address - Street 1:29 BROAD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1052
Practice Address - Country:US
Practice Address - Phone:410-641-4598
Practice Address - Fax:410-641-4696
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD620713-02OtherMD CAREFIRST BCBS
MD2174438OtherCIGNA
MDG934-0002OtherNCA CAREFIRST BCBS
MD4114355OtherMAMSI
MD620713-02OtherMD CAREFIRST BCBS