Provider Demographics
NPI:1124213210
Name:BUCKNER, SARA LYNN (REGISTERED)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:LYNN
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MARION RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1406
Mailing Address - Country:US
Mailing Address - Phone:774-454-1994
Mailing Address - Fax:508-273-2353
Practice Address - Street 1:53 MARION RD UNIT 2
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1406
Practice Address - Country:US
Practice Address - Phone:774-454-1994
Practice Address - Fax:508-273-2353
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician