Provider Demographics
NPI:1700469582
Name:MORENO-BUCKMON, LYNN MARIE (MSED, NCC, LPC ELIGI)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:MORENO-BUCKMON
Suffix:
Gender:F
Credentials:MSED, NCC, LPC ELIGI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 MEDINA ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-3067
Mailing Address - Country:US
Mailing Address - Phone:856-503-9320
Mailing Address - Fax:
Practice Address - Street 1:2275 BRIDGE ST BLDG 5B-132
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1300
Practice Address - Country:US
Practice Address - Phone:215-772-0101
Practice Address - Fax:215-772-0303
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2335808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health