Provider Demographics
NPI:1457437600
Name:BUCKLEY, MARY E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 THOMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277
Mailing Address - Country:US
Mailing Address - Phone:401-465-3388
Mailing Address - Fax:
Practice Address - Street 1:335 E CENTERVILLE RD
Practice Address - Street 2:BLDG 5
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-465-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW000481041C0700X
MA1071881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical