Healthcare Provider Details

I. General information

NPI: 1154022119
Provider Name (Legal Business Name): YOCHENEN BUXBAUM LMSW, CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BOERUM ST
BROOKLYN NY
11206-8189
US

IV. Provider business mailing address

42 S 10TH ST APT 7C2
BROOKLYN NY
11249-7077
US

V. Phone/Fax

Practice location:
  • Phone: 718-400-0545
  • Fax:
Mailing address:
  • Phone: 718-400-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125977-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: