Provider Demographics
NPI:1316064850
Name:BUCKLEY, GERALD C (LISW)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:C
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23875 COMMERCE PARK ROAD
Mailing Address - Street 2:SUITE160
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-378-9000
Mailing Address - Fax:216-378-8900
Practice Address - Street 1:23875 COMMERCE PARK ROAD
Practice Address - Street 2:SUITE160
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-378-9000
Practice Address - Fax:216-378-8900
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI19721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical