Provider Demographics
NPI:1205840584
Name:BUSCH SOMACH, LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:BUSCH SOMACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:26 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2137
Mailing Address - Country:US
Mailing Address - Phone:718-605-6383
Mailing Address - Fax:718-605-6384
Practice Address - Street 1:3930 RICHMOND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5100
Practice Address - Country:US
Practice Address - Phone:718-605-6383
Practice Address - Fax:718-605-6384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY092198OtherVALUE OPTIONS ID
NY6885393OtherGHI PROVIDER ID
NY241097OtherMHN PROVIDER ID
NY01605632Medicaid
NYP2356070OtherOXFORD ID
NY6153853OtherUNITED HEALTHCARE ID
NY241097OtherMHN PROVIDER ID
NYP2356070OtherOXFORD ID