Provider Demographics
NPI:1598373318
Name:BUXBAUM, LAUREL JOAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:JOAN
Last Name:BUXBAUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BELLS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8248
Mailing Address - Country:US
Mailing Address - Phone:215-836-4450
Mailing Address - Fax:
Practice Address - Street 1:18 BELLS MILL RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-8248
Practice Address - Country:US
Practice Address - Phone:215-836-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-00547-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist