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General NPI Number Information
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NPI Number | 1174640668
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Entity Type | Individual
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Provider Name | DANA G. BUSH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 290 HAWKINS AVE STE. B
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-9600
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Country | US
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Telephone | 631-431-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 156 W 56TH ST STE 1804
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City | NEW YORK
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State | NY
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Zip | 10019-3878
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Country | US
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Telephone | 212-851-8100
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Fax | 888-977-2547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013045
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 013045
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 013045
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License Number State | NY
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