Provider Demographics
NPI:1790791234
Name:BUCKNER, LOREN SANDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOREN
Middle Name:SANDY
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 W BUSCH BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4560
Mailing Address - Country:US
Mailing Address - Phone:813-915-0076
Mailing Address - Fax:813-933-3713
Practice Address - Street 1:2805 W BUSCH BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4560
Practice Address - Country:US
Practice Address - Phone:813-915-0076
Practice Address - Fax:813-933-3713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical