Provider Demographics
NPI:1750067898
Name:BUFANO, SUZANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:BUFANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 HARBOR PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4359
Mailing Address - Country:US
Mailing Address - Phone:843-324-9031
Mailing Address - Fax:
Practice Address - Street 1:MUSC HEALTH AT THE CITADEL 171 MOULTRIE STREET
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29409-0001
Practice Address - Country:US
Practice Address - Phone:843-953-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical