Healthcare Provider Details

I. General information

NPI: 1609325679
Provider Name (Legal Business Name): ROBERT BUZAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 BUCKLEY DR
SUMMERFIELD NC
27358-9785
US

IV. Provider business mailing address

3912 BATTLEGROUND AVE STE 112-305
GREENSBORO NC
27410-8575
US

V. Phone/Fax

Practice location:
  • Phone: 828-278-3722
  • Fax: 833-420-1616
Mailing address:
  • Phone: 828-278-3722
  • Fax: 833-420-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4950
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4950
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4950
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: