Provider Demographics
NPI:1437521275
Name:LILA BUCKLIN
Entity Type:Organization
Organization Name:LILA BUCKLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAIST
Authorized Official - Prefix:
Authorized Official - First Name:LILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-642-8929
Mailing Address - Street 1:65 CORNWALL ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 CORNWALL ST UNIT 104
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2696
Practice Address - Country:US
Practice Address - Phone:617-642-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118583251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health