Provider Demographics
NPI:1982414892
Name:BUCKLE, PAMELA MARIE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:BUCKLE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 7TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3325
Mailing Address - Country:US
Mailing Address - Phone:718-403-0236
Mailing Address - Fax:
Practice Address - Street 1:251 7TH ST APT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3325
Practice Address - Country:US
Practice Address - Phone:718-403-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001159-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst