Provider Demographics
NPI:1528054012
Name:BUCKINGHAM, CATHERINE ELIZABETH (PHD HSPP)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:7250 CLEARVISTA DRIVE
Practice Address - Street 2:SUITE 227
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5600
Practice Address - Country:US
Practice Address - Phone:317-621-7804
Practice Address - Fax:317-621-7275
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040938A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01191790OtherRR MEDICARE PTAN
IN200324030Medicaid
INP01678706OtherRR MEDICARE
IN200324030Medicaid
INM400066599Medicare PIN
INP01191790OtherRR MEDICARE PTAN
INM400062845Medicare PIN