Provider Demographics
NPI:1629191044
Name:BUCHHOLTZ, LORETTA (FP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:BUCHHOLTZ
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 N 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5569
Mailing Address - Country:US
Mailing Address - Phone:623-217-2146
Mailing Address - Fax:
Practice Address - Street 1:2713 N 122ND AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5569
Practice Address - Country:US
Practice Address - Phone:623-217-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker