Provider Demographics
NPI:1093709263
Name:BUCHANAN, DENISE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LEE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6494 EDMONTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2513
Mailing Address - Country:US
Mailing Address - Phone:858-717-2719
Mailing Address - Fax:858-408-2468
Practice Address - Street 1:6494 EDMONTON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2513
Practice Address - Country:US
Practice Address - Phone:858-717-2719
Practice Address - Fax:858-408-2468
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACP16447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16447Medicare UPIN