Provider Demographics
NPI:1508239005
Name:BUCHANAN, LATOYA (LCSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:968
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-4414
Mailing Address - Fax:312-864-9500
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:968
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-4414
Practice Address - Fax:312-864-9500
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490178051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical