Provider Demographics
NPI:1245578376
Name:ELIZABETH J. BUCKLEY, PH.D. PA
Entity type:Organization
Organization Name:ELIZABETH J. BUCKLEY, PH.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-665-9664
Mailing Address - Street 1:98 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5323
Mailing Address - Country:US
Mailing Address - Phone:352-665-9664
Mailing Address - Fax:855-601-9484
Practice Address - Street 1:98 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5323
Practice Address - Country:US
Practice Address - Phone:352-665-9664
Practice Address - Fax:855-601-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty