Basic Information
| Provider Information | |||||||||
| NPI: | 1346332491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCKNOR | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | ANDRIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 7TH AVE APT 4 | ||||||||
| Address2: | |||||||||
| City: | ASBURY PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077125435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328692770 | ||||||||
| FaxNumber: | 7328979541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 BOND ST | ||||||||
| Address2: | |||||||||
| City: | ASBURY PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077125939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328692770 | ||||||||
| FaxNumber: | 7328979541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.