Healthcare Provider Details

I. General information

NPI: 1790972800
Provider Name (Legal Business Name): MARIA LIMMIATIS BUCHSBAUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

6926 FOLGER DR
CHARLOTTE NC
28270-5948
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-9414
  • Fax: 704-384-5735
Mailing address:
  • Phone: 704-442-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003492
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: