Provider Demographics
NPI:1184777856
Name:BUCHANEK, ELIZABETH M (MSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:BUCHANEK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 KENTBURY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4615
Mailing Address - Country:US
Mailing Address - Phone:301-654-8517
Mailing Address - Fax:301-654-8517
Practice Address - Street 1:7917 KENTBURY DRIVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4615
Practice Address - Country:US
Practice Address - Phone:301-654-8517
Practice Address - Fax:301-654-8517
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCSWC3119103T00000X
DCLICSWLC003000961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490993Medicare ID - Type Unspecified
MD490993Medicare UPIN