Provider Demographics
NPI:1265613046
Name:BUCKLEY, BREANNA KATE FINNERON (LCSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:KATE FINNERON
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:KATE
Other - Last Name:FINNERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 N SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1755
Mailing Address - Country:US
Mailing Address - Phone:315-471-1564
Mailing Address - Fax:315-396-0114
Practice Address - Street 1:329 N SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1755
Practice Address - Country:US
Practice Address - Phone:315-471-1564
Practice Address - Fax:315-396-0114
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY0948691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker