Provider Demographics
NPI:1285874354
Name:BUCHANAN, FREDERICK GRISWOLD
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:GRISWOLD
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9-15 ADRIAN AVENUE
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:BRONX, NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:347-453-6841
Mailing Address - Fax:
Practice Address - Street 1:9-15 ADRIAN AVENUE
Practice Address - Street 2:SUITE 6A
Practice Address - City:BRONX, NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:347-453-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR22337103K00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical