Provider Demographics
NPI:1801851779
Name:BUCKLEY-WHITE, JOAN D (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:D
Last Name:BUCKLEY-WHITE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:D
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 S. SALINA STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-476-7921
Mailing Address - Fax:315-475-1448
Practice Address - Street 1:819 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3536
Practice Address - Country:US
Practice Address - Phone:315-476-7921
Practice Address - Fax:315-475-1448
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04317520Medicaid
NY04317520Medicaid