Provider Demographics
NPI:1457509069
Name:BUCHMAN, BROOKE MOORE (MA, LPA)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MOORE
Last Name:BUCHMAN
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-1437
Mailing Address - Country:US
Mailing Address - Phone:919-550-0500
Mailing Address - Fax:919-550-5120
Practice Address - Street 1:221 BARBOUR ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2403
Practice Address - Country:US
Practice Address - Phone:919-550-0500
Practice Address - Fax:919-550-5120
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3608103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107579Medicaid