Provider Demographics
NPI:1194931600
Name:BUCHHOLZ-CASTRONOVA, MARJORIE (MS)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:BUCHHOLZ-CASTRONOVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:BUCHHOLZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1092 MOONLIT OASIS LN UNIT 103
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0625
Mailing Address - Country:US
Mailing Address - Phone:170-248-0417
Mailing Address - Fax:
Practice Address - Street 1:1790 W PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3112
Practice Address - Country:US
Practice Address - Phone:909-558-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116112106H00000X
NV0832106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist