Healthcare Provider Details

I. General information

NPI: 1104751460
Provider Name (Legal Business Name): TARA BUCHY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W 5TH ST
DAYTON OH
45402-8306
US

IV. Provider business mailing address

907 W 5TH ST
DAYTON OH
45402-8306
US

V. Phone/Fax

Practice location:
  • Phone: 937-764-2373
  • Fax:
Mailing address:
  • Phone: 937-764-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TARA BUCHY
Title or Position: OWNER
Credential: MSW, LISW
Phone: 937-764-2373