Provider Demographics
NPI:1780993634
Name:BUKSAR, CATHERINE MARIE (MA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:BUKSAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 COLUMBIA AVE
Mailing Address - Street 2:SUITE E2
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3538
Mailing Address - Country:US
Mailing Address - Phone:219-595-0043
Mailing Address - Fax:312-754-9402
Practice Address - Street 1:9250 COLUMBIA AVE
Practice Address - Street 2:SUITE E2
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3538
Practice Address - Country:US
Practice Address - Phone:219-595-0043
Practice Address - Fax:312-754-9402
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IN20043119A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist