Provider Demographics
NPI:1205867991
Name:BUCHANAN, RETA NELL (MSW)
Entity Type:Individual
Prefix:
First Name:RETA
Middle Name:NELL
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-0716
Mailing Address - Country:US
Mailing Address - Phone:845-292-8770
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-0716
Practice Address - Country:US
Practice Address - Phone:845-292-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398370Medicaid