Provider Demographics
NPI:1922288018
Name:BUFF, GARY BERNARD (EDD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:BERNARD
Last Name:BUFF
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1752
Mailing Address - Country:US
Mailing Address - Phone:808-326-5629
Mailing Address - Fax:808-329-5057
Practice Address - Street 1:75-5751 KUAKINI HWY
Practice Address - Street 2:STE 101 A
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1752
Practice Address - Country:US
Practice Address - Phone:808-326-5629
Practice Address - Fax:808-329-5057
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1022103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling