Provider Demographics
NPI:1881382372
Name:BUCK, DAVID (LMSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BUCK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FROSTFIELD DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9241
Mailing Address - Country:US
Mailing Address - Phone:425-691-0426
Mailing Address - Fax:
Practice Address - Street 1:810 FROSTFIELD DR APT 1A
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9241
Practice Address - Country:US
Practice Address - Phone:425-691-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor