Provider Demographics
NPI:1467598680
Name:BUCKLEY, ELIZABETH L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:L
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:STE 185
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5075
Mailing Address - Country:US
Mailing Address - Phone:781-526-0158
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:STE 185
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5075
Practice Address - Country:US
Practice Address - Phone:781-526-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10322351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical