Provider Demographics
NPI:1629212048
Name:BUCKLAND, MARY CATHERINE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:BUCKLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:467 LAKE HOWELL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5922
Mailing Address - Country:US
Mailing Address - Phone:407-331-7717
Mailing Address - Fax:407-331-7709
Practice Address - Street 1:467 LAKE HOWELL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5922
Practice Address - Country:US
Practice Address - Phone:407-331-7717
Practice Address - Fax:407-331-7709
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ154JOtherBLUE CROSS BLUE SHIELD