Antanique Revesha Edmonds Buckley, LICSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26173 Issued in MD

Practice address

9868 Softwater Way
Columbia, MD 21046-1825

Phone

(443) 583-4421

NPI assigned

May 4, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other names 1

• Antanique Buckley Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• New Avenues Counseling LLC

  • Clinical Social Worker
  • Columbia, MD
  • NPI 1487357661
  NPD Authorized official

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680307200000",
    "number": "1811374465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9868 SOFTWATER WAY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210461825",
            "telephone_number": "443-583-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9868 SOFTWATER WAY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210461825",
            "telephone_number": "443-583-4421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7850 Contee Rd Apt 483",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MD",
            "postal_code": "207079268",
            "country_code": "US",
            "telephone_number": "810-610-4190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2702 Flushing Rd",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485044534",
            "country_code": "US",
            "telephone_number": "810-424-5998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDMONDS BUCKLEY",
        "first_name": "ANTANIQUE",
        "middle_name": "REVESHA",
        "credential": "LICSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-04",
        "last_updated": "2023-04-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801096954",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC500825825",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904014720",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "26173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTANIQUE",
            "last_name": "BUCKLEY",
            "credential": "MSW, LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Elinor Eden
• Angelia Danielle Edens, APRN
• Gia Edge
• Nicholas Edler
• Opal Edmiston
• Jessica Tyler Edmonds
• Edward P Dworkin PH D & Anita L Dworkin PH D P a
• Amara Edwards
• Denise Edwards, PT
• Devon Anthony Edwards

• Clinical Social Worker in Columbia, MD
• Providers in Columbia, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.