Provider Demographics
NPI:1174191324
Name:BUSH, BRIEA ALVEDA (CARE MANAGER,)
Entity Type:Individual
Prefix:
First Name:BRIEA
Middle Name:ALVEDA
Last Name:BUSH
Suffix:
Gender:F
Credentials:CARE MANAGER,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3703
Mailing Address - Country:US
Mailing Address - Phone:646-397-3454
Mailing Address - Fax:646-837-0510
Practice Address - Street 1:337 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3703
Practice Address - Country:US
Practice Address - Phone:646-397-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator