Provider Demographics
NPI:1194979823
Name:BUCKLEY, MEGHAN H (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:H
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 FAIRVIEW AVE
Mailing Address - Street 2:APT C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2956
Mailing Address - Country:US
Mailing Address - Phone:410-934-7826
Mailing Address - Fax:410-934-7826
Practice Address - Street 1:774 FAIRVIEW AVE
Practice Address - Street 2:APT C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2956
Practice Address - Country:US
Practice Address - Phone:410-934-7826
Practice Address - Fax:410-934-7826
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04511103TC0700X
VA0810004006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical