Mary Kathleen Buckley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW11572 Issued in CA

Practice address

1357 W Shaw Ave Ste 102
Fresno, CA 93711-3619

Phone

(559) 464-5279

Fax

(866) 812-5195

NPI assigned

Feb 20, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Social Worker

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mary Kay Buckley, Psychotherapist Inc

  • Community/Behavioral Health Agency
  • Fresno, CA
  • NPI 1710509377
  NPD Authorized official

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1992045439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 W SHAW AVE STE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113619",
            "telephone_number": "559-250-6715",
            "fax_number": "866-812-5195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 W SHAW AVE STE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113619",
            "telephone_number": "559-464-5279",
            "fax_number": "866-812-5195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1357 W Shaw Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937113619",
            "country_code": "US",
            "telephone_number": "559-250-6715",
            "fax_number": "866-812-5195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-20",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW11572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7246041",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "CA21889391",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ26585Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamile Bucio
• Alexis Marie Buck
• John T Buck, DDS
• Robert Kendall Buckenberger, DPM
• Robin Lee Buckle, R.N., C.P.N.P.
• Kendla K. Buckowski
• April Bucu, RN
• Praveen Buddiga, M.D.
• Paul D Budzik, D.D.S.
• Kelsey Masson Buehler, DO

• Clinical Social Worker in Fresno, CA
• Providers in Fresno, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.