Provider Demographics
NPI:1720251341
Name:BUCKLEY, DAVID P (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1205
Mailing Address - Country:US
Mailing Address - Phone:609-631-2800
Mailing Address - Fax:
Practice Address - Street 1:3575 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1205
Practice Address - Country:US
Practice Address - Phone:609-631-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00375800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical