Provider Demographics
NPI:1750490785
Name:BUCKALEW, CAROLYN M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:M
Last Name:BUCKALEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:ZABLONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1617 E NECTARINE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-4966
Mailing Address - Country:US
Mailing Address - Phone:805-736-3185
Mailing Address - Fax:
Practice Address - Street 1:CALM
Practice Address - Street 2:1236 CHAPALA STREET
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-737-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070789-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical