Provider Demographics
NPI:1265661672
Name:BUCHWALD, ANITA S (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:BUCHWALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AIDEL
Other - Middle Name:
Other - Last Name:BUCHWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:330 W 72ND ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2644
Mailing Address - Country:US
Mailing Address - Phone:212-362-6516
Mailing Address - Fax:212-362-6516
Practice Address - Street 1:330 W 72ND ST APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2644
Practice Address - Country:US
Practice Address - Phone:212-362-6516
Practice Address - Fax:212-362-6516
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0173251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR017325OtherLCSW LICENSE