Provider Demographics
NPI:1518180207
Name:BUCHANAN, MARIEANNE - (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIEANNE
Middle Name:-
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 WALDON PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1336
Mailing Address - Country:US
Mailing Address - Phone:248-391-2772
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-335-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010714581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical