Provider Demographics
NPI:1447408927
Name:BUCKLEY, VANJA PETROMAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:VANJA
Middle Name:PETROMAN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 S BIG BEND BLVD
Mailing Address - Street 2:#200
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:636-549-7700
Mailing Address - Fax:
Practice Address - Street 1:1053 S BIG BEND BLVD
Practice Address - Street 2:#200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1605
Practice Address - Country:US
Practice Address - Phone:636-549-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health