Provider Demographics
NPI:1417416983
Name:BUFFALOE, DEBBIE L (LICSW,PIP)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:L
Last Name:BUFFALOE
Suffix:
Gender:F
Credentials:LICSW,PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4878
Mailing Address - Country:US
Mailing Address - Phone:256-768-1550
Mailing Address - Fax:
Practice Address - Street 1:203 PLUM ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4878
Practice Address - Country:US
Practice Address - Phone:256-768-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3920C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3920COtherSOCIAL WORK LICENSURE