Healthcare Provider Details

I. General information

NPI: 1871969402
Provider Name (Legal Business Name): MARY M BUXTON LCSW, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 LOS GATOS BLVD #14
LOS GATOS CA
95032-3428
US

IV. Provider business mailing address

15951 LOS GATOS BLVD #14
LOS GATOS CA
95032-3488
US

V. Phone/Fax

Practice location:
  • Phone: 408-371-4847
  • Fax:
Mailing address:
  • Phone: 408-371-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLCS7780
License Number StateCA

VIII. Authorized Official

Name: MARY MARTIN BUXTON
Title or Position: PSYCHOTHERAPIST
Credential: LCSW 7780
Phone: 408-810-8624