Kathleen Janel Buckley

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW16183 Issued in FL

Practice address

1613 Wind Drift Rd
Belle Isle, FL 32809-6838

Phone

(773) 590-2381

NPI assigned

Aug 27, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1598486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1548873714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1613 WIND DRIFT RD",
            "city": "BELLE ISLE",
            "state": "FL",
            "postal_code": "328096838",
            "telephone_number": "773-590-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 WIND DRIFT RD",
            "city": "BELLE ISLE",
            "state": "FL",
            "postal_code": "328096838",
            "telephone_number": "773-590-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "KATHLEEN",
        "middle_name": "JANEL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-27",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.008482",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Sanvello",
            "affiliation": "Y",
            "affiliationName": "Sanvello Behavioral Health Services, P.A.",
            "address_1": "1613 Wind Drift Rd",
            "city": "Belle Isle",
            "state": "FL",
            "country_code": "US",
            "postal_code": "328096838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Danielle Elizabeth Bergman, APRN
• Tiffany Cary, MA CCC-SLP
• Tara Cunningham, MOT, OTR/L, ATP
• Dawn Curtis
• Lauren Day, APRN
• Empirical Pediatric Therapy LLC

• Clinical Social Worker in Belle Isle, FL
• Providers in Belle Isle, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.