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General NPI Number Information
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NPI Number | 1871969402
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Entity Type | Organization
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Legal Business Name | MARY M BUXTON LCSW, INC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 15951 LOS GATOS BLVD #14
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City | LOS GATOS
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State | CA
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Zip | 95032-3428
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Country | US
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Telephone | 408-371-4847
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Fax |
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Provider Business Mailing Address
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Address Line | 15951 LOS GATOS BLVD #14
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City | LOS GATOS
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State | CA
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Zip | 95032-3488
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Country | US
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Telephone | 408-371-4847
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MARY MARTIN BUXTON
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Credential | LCSW 7780
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Telephone | 408-810-8624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LCS7780
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License Number State | CA
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