Provider Demographics
NPI:1235142191
Name:BUCHANAN, JOHN PATRICK (LISW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SOL RIO CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3070
Mailing Address - Country:US
Mailing Address - Phone:505-345-3725
Mailing Address - Fax:
Practice Address - Street 1:6729 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6114
Practice Address - Country:US
Practice Address - Phone:505-342-4678
Practice Address - Fax:505-242-4739
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-38981041C0700X
TNLSW00000042901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical