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NPI Code Detail

MEDICARE: CORRINA VALDEZ-BUSH LMSW

MEDICARE: CORRINA VALDEZ-BUSH LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker098068NY
2104100000XSocial Worker111688-01NY

General Provider Information

NPI Number : 1750018594
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORRINA VALDEZ-BUSH LMSW
Provider Business Mailing Address
First Line : PO BOX 6550
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-6550
Country : US
Telephone Number : 315-782-7445
Fax Number : 315-777-9615
Provider Business Practice Location Address
First Line : 211 JB WISE PL
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2507
Country : US
Telephone Number : 315-782-7445
Fax Number : 315-779-1184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2022
Last Update Date : 07/22/2024

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