Provider Demographics
NPI:1083797310
Name:BUCHANAN, LAURIE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4316
Mailing Address - Country:US
Mailing Address - Phone:508-651-3229
Mailing Address - Fax:
Practice Address - Street 1:169 ELM STREET
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5356
Practice Address - Country:US
Practice Address - Phone:781-894-8440
Practice Address - Fax:781-894-1202
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287OtherMBHP
MANP01332OtherBOSTON MEDICAL
MA1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MA1303287Medicaid
MA703136OtherTUFTS
MAM18633OtherBCBS
MA1303287Medicaid