Provider Demographics
NPI:1568601649
Name:BUCKLAEW, LINDA BARBARA (LCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BARBARA
Last Name:BUCKLAEW
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:BARBARA
Other - Last Name:RUTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-398-2374
Mailing Address - Fax:757-889-3439
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-398-2374
Practice Address - Fax:757-889-3439
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical