Provider Demographics
NPI:1457464661
Name:BUCKLEY, PEPPER DECKERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEPPER
Middle Name:DECKERT
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 DAHLIA TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1174
Mailing Address - Country:US
Mailing Address - Phone:301-987-7278
Mailing Address - Fax:301-987-7279
Practice Address - Street 1:11516 DAHLIA TER
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1174
Practice Address - Country:US
Practice Address - Phone:301-987-7278
Practice Address - Fax:301-987-7279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist