Provider Demographics
NPI:1790024578
Name:BUXBAUM, ANNE KATHERINE (MFT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHERINE
Last Name:BUXBAUM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 AIRWAY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2065
Mailing Address - Country:US
Mailing Address - Phone:707-544-3299
Mailing Address - Fax:707-703-4910
Practice Address - Street 1:3440 AIRWAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2065
Practice Address - Country:US
Practice Address - Phone:707-544-3299
Practice Address - Fax:707-703-4910
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist