Provider Demographics
NPI:1770206468
Name:BUCKLEY, LORI (PSYD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 VISTA TULOCAY LN UNIT 302
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3062
Mailing Address - Country:US
Mailing Address - Phone:626-893-4208
Mailing Address - Fax:
Practice Address - Street 1:788 VISTA TULOCAY LN UNIT 302
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3062
Practice Address - Country:US
Practice Address - Phone:626-893-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20447103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist