Provider Demographics
NPI:1942566096
Name:BUCKLEY, ROSANNE M
Entity Type:Individual
Prefix:MS
First Name:ROSANNE
Middle Name:M
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSANNE
Other - Middle Name:M
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-4174
Mailing Address - Country:US
Mailing Address - Phone:530-865-1146
Mailing Address - Fax:530-865-6483
Practice Address - Street 1:1187 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-9136
Practice Address - Country:US
Practice Address - Phone:530-865-1146
Practice Address - Fax:530-865-6483
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0806230855101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)