Provider Demographics
NPI:1194810200
Name:BUCKLEY, DONNA CECELIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:CECELIA
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LINDSEY CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742
Mailing Address - Country:US
Mailing Address - Phone:631-730-5311
Mailing Address - Fax:
Practice Address - Street 1:27 LINDSEY CT
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742
Practice Address - Country:US
Practice Address - Phone:631-730-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0382791104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3M261Medicare ID - Type Unspecified