Healthcare Provider Details

I. General information

NPI: 1144657362
Provider Name (Legal Business Name): VANESSA BUI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 ATLANTIC AVE SUITE 103
LONG BEACH CA
90807-3536
US

IV. Provider business mailing address

3939 ATLANTIC AVE SUITE 103
LONG BEACH CA
90807-3536
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8480
  • Fax:
Mailing address:
  • Phone: 626-577-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: