Provider Demographics
NPI:1972921179
Name:BUCKINGHAM, CASSANDRA (RBT)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 BUFORT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7905 SCHATZ POINTE DR.
Practice Address - Street 2:SUITE 104
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-952-6379
Practice Address - Fax:937-688-4890
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2021-10-07
Deactivation Date:2020-11-24
Deactivation Code:
Reactivation Date:2021-10-05
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OHRBT-16-18385106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst