Provider Demographics
NPI:1255084844
Name:BUCKLEY, MICHAEL S (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1R NEWBURY ST STE 401
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3816
Mailing Address - Country:US
Mailing Address - Phone:617-804-2773
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5100
Practice Address - Country:US
Practice Address - Phone:781-480-3946
Practice Address - Fax:781-480-3952
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS08907832101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor