Provider Demographics
NPI:1578924361
Name:BUCKMAN, BLAIR MICHELE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:MICHELE
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VILLAGE SQUARE XING STE 2B
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3227
Mailing Address - Country:US
Mailing Address - Phone:561-676-5755
Mailing Address - Fax:
Practice Address - Street 1:400 VILLAGE SQUARE XING STE 2B
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3227
Practice Address - Country:US
Practice Address - Phone:561-676-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor