Provider Demographics
NPI:1942367875
Name:BUCKWALTER, NANCY JEANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEANNE
Last Name:BUCKWALTER
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 1:6 COLTS MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1886
Mailing Address - Country:US
Mailing Address - Phone:484-888-1310
Mailing Address - Fax:267-238-4424
Practice Address - Street 1:47 MARCHWOOD RD
Practice Address - Street 2:SUITE 1-E
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1835
Practice Address - Country:US
Practice Address - Phone:610-524-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11547138OtherCAQH