Provider Demographics
NPI:1053966002
Name:DEPEINE, LAVERN BUCKNOR (LMFT)
Entity type:Individual
Prefix:
First Name:LAVERN
Middle Name:BUCKNOR
Last Name:DEPEINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNELLEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1644
Mailing Address - Country:US
Mailing Address - Phone:732-305-8116
Mailing Address - Fax:
Practice Address - Street 1:32 WERNIK PL STE G
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2467
Practice Address - Country:US
Practice Address - Phone:732-902-2181
Practice Address - Fax:732-902-2182
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00190900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist