Provider Demographics
NPI:1932638897
Name:BUCHANAN, ANGEL MEHTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MEHTA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3231
Mailing Address - Country:US
Mailing Address - Phone:847-906-3900
Mailing Address - Fax:
Practice Address - Street 1:115 15TH ST
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3231
Practice Address - Country:US
Practice Address - Phone:847-906-3900
Practice Address - Fax:847-906-3997
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical