Healthcare Provider Details

I. General information

NPI: 1568455202
Provider Name (Legal Business Name): LEWISE L. BUSCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 7TH ST SE
WASHINGTON DC
20003-2768
US

IV. Provider business mailing address

4125 36TH ST S
ARLINGTON VA
22206-1805
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-4645
  • Fax: 202-543-4476
Mailing address:
  • Phone: 202-543-4645
  • Fax: 202-543-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1527
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002292
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: