Basic Information
Provider Information
NPI: 1700450731
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUCHNER
FirstName: ALEXANDRA
MiddleName: RENEE
NamePrefix: MISS
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 55 DODGE RD
Address2:  
City: GETZVILLE
State: NY
PostalCode: 140681205
CountryCode: US
TelephoneNumber: 7168312700
FaxNumber:  
Practice Location
Address1: 699 HERTEL AVE STE 350
Address2:  
City: BUFFALO
State: NY
PostalCode: 142072341
CountryCode: US
TelephoneNumber: 7168311977
FaxNumber: 7168311985
Other Information
ProviderEnumerationDate: 05/14/2021
LastUpdateDate: 08/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  N Behavioral Health & Social Service ProvidersSocial Worker 
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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