Provider Demographics
NPI:1467594127
Name:BUSICO, VANESSA (MFTI)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BUSICO
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5615
Mailing Address - Country:US
Mailing Address - Phone:858-410-1067
Mailing Address - Fax:
Practice Address - Street 1:1122 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5615
Practice Address - Country:US
Practice Address - Phone:858-410-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health