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General NPI Number Information
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NPI Number | 1235142191
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Entity Type | Individual
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Provider Name | JOHN PATRICK BUCHANAN L.I.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6729 4TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6114
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Country | US
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Telephone | 505-342-4678
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Fax | 505-242-4739
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Provider Business Mailing Address
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Address Line | 1901 SOL RIO CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3070
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Country | US
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Telephone | 505-345-3725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-3898
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW0000004290
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License Number State | TN
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