Provider Demographics
NPI:1174037659
Name:BUCHANAN, DIANE CAROLYN (PHD, PSYD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROLYN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 LANSING ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5353
Mailing Address - Country:US
Mailing Address - Phone:321-779-6848
Mailing Address - Fax:
Practice Address - Street 1:146 LANSING ISLAND DR
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5353
Practice Address - Country:US
Practice Address - Phone:321-779-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty