Provider Demographics
NPI:1982784856
Name:BUCKMAN, DAVID MARK (MEDLMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:MEDLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 SWEET BASIL JANE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-9396
Mailing Address - Country:US
Mailing Address - Phone:850-942-5622
Mailing Address - Fax:
Practice Address - Street 1:1840 FIDDLER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4450
Practice Address - Country:US
Practice Address - Phone:850-942-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 1721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health