Provider Demographics
NPI:1922273051
Name:BUCKLEY, GEOFFREY A (MS, MDIV, PHD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MS, MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 RUDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4631
Mailing Address - Country:US
Mailing Address - Phone:805-405-0641
Mailing Address - Fax:
Practice Address - Street 1:393 RUDOLPH DR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4631
Practice Address - Country:US
Practice Address - Phone:805-405-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMC20781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist