Provider Demographics
NPI:1033232202
Name:BUSCH, KAREN A (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 DOVE ST STE 285
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2843
Mailing Address - Country:US
Mailing Address - Phone:949-752-8550
Mailing Address - Fax:949-640-6643
Practice Address - Street 1:1151 DOVE ST STE 285
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2843
Practice Address - Country:US
Practice Address - Phone:949-752-8550
Practice Address - Fax:949-640-6643
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4099OtherL.C.S.W. LICENSE NUMBER