Provider Demographics
NPI:1215229778
Name:BUCHANAN, MAUREEN J (MS IN EDUCATION -)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:J
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS IN EDUCATION -
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PRINCESSTREE COURT
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1742
Mailing Address - Country:US
Mailing Address - Phone:631-473-6188
Mailing Address - Fax:
Practice Address - Street 1:11 PRINCESSTREE COURT
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1742
Practice Address - Country:US
Practice Address - Phone:631-473-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002239-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist