Provider Demographics
NPI:1629680939
Name:BUCKLEY MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BUCKLEY MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:413-441-9921
Mailing Address - Street 1:25 COPLEY TER
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6434
Mailing Address - Country:US
Mailing Address - Phone:413-441-9921
Mailing Address - Fax:
Practice Address - Street 1:132 MASS MOCA WAY
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2446
Practice Address - Country:US
Practice Address - Phone:413-664-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)