Healthcare Provider Details

I. General information

NPI: 1003805334
Provider Name (Legal Business Name): ANNE B. BUSSARD LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 GROFF RD
HORSEHEADS NY
14845-7925
US

IV. Provider business mailing address

17 GROFF RD
HORSEHEADS NY
14845-7925
US

V. Phone/Fax

Practice location:
  • Phone: 607-738-0733
  • Fax: 607-562-8854
Mailing address:
  • Phone: 607-738-0733
  • Fax: 607-562-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR 053342-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: