Provider Demographics
NPI:1982831327
Name:BUCHAL, LISA L (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:BUCHAL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:2525 CHICAGO AVENUE SOUTH, 32-B852
Mailing Address - Street 2:CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4518
Mailing Address - Country:US
Mailing Address - Phone:612-813-6645
Mailing Address - Fax:612-813-6319
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH, 32-B852
Practice Address - Street 2:CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6645
Practice Address - Fax:612-813-6319
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN08771104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical