Healthcare Provider Details

I. General information

NPI: 1770594962
Provider Name (Legal Business Name): LORI LEE BUELNA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 SILVER CREEK VALLEY RD
SAN JOSE CA
95138-1059
US

IV. Provider business mailing address

5855 SILVER CREEK VALLEY PLACE
SAN JOSE CA
95138
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: