Provider Demographics
NPI:1013469600
Name:BUCK, ASHLEY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MARIE
Last Name:BUCK
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:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:HYDE
Mailing Address - State:PA
Mailing Address - Zip Code:16843-0564
Mailing Address - Country:US
Mailing Address - Phone:814-771-5254
Mailing Address - Fax:
Practice Address - Street 1:30 W PARK AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2452
Practice Address - Country:US
Practice Address - Phone:814-771-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133530104100000X
PACW0216371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker