1760640916 NPI number — MS. MELANIE DARLENE BUSH LCSW

Table of content: MS. MELANIE DARLENE BUSH LCSW (NPI 1760640916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760640916 NPI number — MS. MELANIE DARLENE BUSH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSH
Provider First Name:
MELANIE
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760640916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 WEST ST
Provider Second Line Business Mailing Address:
CARTHAGE AREA HOSPITAL
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13619-9703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-493-5080
Provider Business Mailing Address Fax Number:
315-493-5082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36500 RTE 26
Provider Second Line Business Practice Location Address:
CARTHAGE CENTRAL HIGH SCHOOL-SCHOOL BASED HEALTH CLINIC
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13619-9506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-493-5080
Provider Business Practice Location Address Fax Number:
315-493-5082
Provider Enumeration Date:
05/23/2008

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: 104100000X , with the licence number:  078262 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 080739 , 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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