1568601649 NPI number — LINDA BARBARA BUCKLAEW LCSW, CEAP

Table of content: LINDA BARBARA BUCKLAEW LCSW, CEAP (NPI 1568601649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568601649 NPI number — LINDA BARBARA BUCKLAEW LCSW, CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKLAEW
Provider First Name:
LINDA
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CEAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUTKOWSKI
Provider Other First Name:
LINDA
Provider Other Middle Name:
BARBARA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568601649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 EXECUTIVE DR STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-6604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-827-7707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4034 GEORGE WASHINGTON MEM HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORKTOWN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23692-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-598-2244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904005777 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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