NPIMap

Organization Active NPI

Blue Heron Psychology, LLC

  • Clinical Psychologist
  • Annapolis, MD
National Provider Identifier
1386183283
Registry record updated Feb 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
04511 Issued in MD
Legal business name
BLUE HERON PSYCHOLOGY, LLC
Practice address
774 Fairview Ave
Apt C
Annapolis, MD 21403-2956
Phone
(410) 934-7826
Fax
(410) 934-7826
NPI assigned
Feb 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Meghan H Buckley, PSY.D.NPI 1194979823
Title
Licensed Psychologist/Owner
Phone
(410) 934-7826

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 04511 MD Primary

Addresses

Primary practice location

774 Fairview Ave
Apt C
Annapolis, MD 21403-2956

Mailing address

774 Fairview Ave
Apt C
Annapolis, MD 21403-2956
Phone (410) 934-7826

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1386183283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 FAIRVIEW AVE",
            "address_2": "APT C",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214032956",
            "telephone_number": "410-934-7826",
            "fax_number": "410-934-7826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 FAIRVIEW AVE",
            "address_2": "APT C",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214032956",
            "telephone_number": "410-934-7826",
            "fax_number": "410-934-7826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "MEGHAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "410-934-7826",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "04511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.