Provider Demographics
NPI:1023586054
Name:BUCKLEY LECLERC, TAMARA ANN
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:BUCKLEY LECLERC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 WEST RD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-2240
Mailing Address - Country:US
Mailing Address - Phone:978-386-2379
Mailing Address - Fax:
Practice Address - Street 1:29 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1400
Practice Address - Country:US
Practice Address - Phone:508-755-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist