Provider Demographics
NPI:1811066855
Name:BUCK, STEVEN ANTHONY (LICSW)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:BUCK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1493 CAMBRIDGE ST.
Mailing Address - Street 2:CAMBRIDGE HEALTH ALLIANCE
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-665-1807
Mailing Address - Fax:617-665-1020
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:CAMBRIDGE HEALTH ALLIANCE
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1807
Practice Address - Fax:617-665-1020
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1078211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010OtherMBHP
MA500504OtherTUFTS
MA984033OtherNETWORK HEALTH
MA1211951Medicaid
MALICSWOtherDISCIPLINE
MA984033OtherNETWORK HEALTH