Lisa M Buckloh, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PY6027 Issued in FL

Practice address

807 Childrens Way
Jacksonville, FL 32207-8426

Phone

(904) 390-3600

Fax

(904) 390-3512

NPI assigned

Aug 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1386658615
  Medicare reassignment NPD
• The Nemours Foundation

  • Children's Hospital
  • Wilmington, DE
  • NPI 1467505073
  NPD

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1811003734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "address_2": "PROVIDER ENROLLMENT DEPT",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-6212",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 CHILDRENS WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078426",
            "telephone_number": "904-390-3600",
            "fax_number": "904-390-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLOH",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY6027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000846942A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jami Lea Gann Buckley, MD
• Kerry Louise Buckley, M.D.
• Nasja Aaliyah Buckley
• Stephen Leslie Buckley, M.D.
• Valerie Buckley, MA, CAS, PSY.D.
• Jonathan Coulter Buckman
• Albert Lee. Buckner III, B.A, M. ED
• Ricky Alan Buckshaw Jr., D.O.
• Pamela Buday, PA
• Alexandra Budd, ARNP

• Clinical Child & Adolescent Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.