Provider Demographics
NPI:1851597223
Name:BUFORD, PENNY NICHOLS (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:NICHOLS
Last Name:BUFORD
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 1:16595 EDINBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4018
Mailing Address - Country:US
Mailing Address - Phone:313-461-1142
Mailing Address - Fax:
Practice Address - Street 1:16595 EDINBOROUGH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4018
Practice Address - Country:US
Practice Address - Phone:313-461-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041CO700X1041C0700X
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator