Provider Demographics
NPI:1205499324
Name:BRIDGETT BUCKERY LCSW PLLC
Entity type:Organization
Organization Name:BRIDGETT BUCKERY LCSW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT , CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:718-415-0871
Mailing Address - Street 1:19011 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3324
Mailing Address - Country:US
Mailing Address - Phone:718-415-0871
Mailing Address - Fax:
Practice Address - Street 1:19011 119TH AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3324
Practice Address - Country:US
Practice Address - Phone:718-415-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty