Provider Demographics
NPI:1467612358
Name:BUSH, SARAH E (LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BUSH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2201
Mailing Address - Street 2:
Mailing Address - City:WEST DOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05356-2201
Mailing Address - Country:US
Mailing Address - Phone:781-530-4842
Mailing Address - Fax:
Practice Address - Street 1:58 CONCORD ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2602
Practice Address - Country:US
Practice Address - Phone:781-530-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health