Doctor Name: | TODD CHARLES BUCKLEY |
NPI Number: | 1225120306 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 7869 |
Business Practice Address: | 169 W Main St 2nd Floor Hopkinton, MA - 017482175 |
Business Phone Number: | 5084353066 |
Business Fax Number: | 5084352011 |
Mailing Address: | 199 Sprague St, NORTHBRIDGE |
State: | MA |
Postal Code: | 015341029 |
Phone Number: | 5082344375 |
Fax Number: | 5084352011 |
NPI Enumeration Date: | 09/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 7869 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |