Provider Demographics
NPI:1629304670
Name:BUCKLEY, MARCIEA W (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCIEA
Middle Name:W
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 GOVERMENT WAY
Mailing Address - Street 2:#136
Mailing Address - City:COEUR D' ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-664-8347
Mailing Address - Fax:208-664-9217
Practice Address - Street 1:109 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:COEUR D' ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-664-8347
Practice Address - Fax:208-664-9217
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LSW-24847104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker