1144659103 NPI number — MRS. KATHRYN AMANDA BUSCH L.M.F.T.

Table of content: MRS. KATHRYN AMANDA BUSCH L.M.F.T. (NPI 1144659103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144659103 NPI number — MRS. KATHRYN AMANDA BUSCH L.M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSCH
Provider First Name:
KATHRYN
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEDDES
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
AMANDA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144659103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 PAMELA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-3155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-946-6818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MONTAUK HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11715-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-258-5587
Provider Business Practice Location Address Fax Number:
631-363-0027
Provider Enumeration Date:
11/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  001044 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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