Provider Demographics
NPI:1831731124
Name:BUCKINGHAM, PAUL STEVEN (PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:STEVEN
Last Name:BUCKINGHAM
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 1:55-510 KAMEHAMEHA HWY STE 15
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1119
Mailing Address - Country:US
Mailing Address - Phone:808-780-6925
Mailing Address - Fax:
Practice Address - Street 1:55-510 KAMEHAMEHA HWY STE 15
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1119
Practice Address - Country:US
Practice Address - Phone:808-780-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI34561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical