Provider Demographics
NPI:1265446413
Name:BUSH, MARTHA WATKINS (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:WATKINS
Last Name:BUSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 E WILLOW GROVE AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038
Mailing Address - Country:US
Mailing Address - Phone:215-884-3903
Mailing Address - Fax:215-836-0300
Practice Address - Street 1:1108 E WILLOW GROVE AVE
Practice Address - Street 2:2ND FL
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038
Practice Address - Country:US
Practice Address - Phone:215-884-3903
Practice Address - Fax:215-836-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist