Provider Demographics
NPI:1265610935
Name:BUCKLEY, ANN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BUCKLEY
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 1:4001 W 15TH ST
Mailing Address - Street 2:SUITE 465
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5841
Mailing Address - Country:US
Mailing Address - Phone:469-246-1314
Mailing Address - Fax:972-969-2475
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:SUITE 465
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:469-246-1314
Practice Address - Fax:972-969-2475
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32147104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker