Provider Demographics
NPI:1720027857
Name:BUCKNER, GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FURNACE DOCK RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6603
Mailing Address - Country:US
Mailing Address - Phone:914-736-9822
Mailing Address - Fax:516-747-4783
Practice Address - Street 1:145 E 27TH ST
Practice Address - Street 2:SUITE 10K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9017
Practice Address - Country:US
Practice Address - Phone:212-686-4381
Practice Address - Fax:516-747-4783
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024137-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR024137-1OtherLCSW
NYR024137-1OtherLCSW