Provider Demographics
NPI:1467680876
Name:VANDER BUSH, LAURA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:VANDER BUSH
Suffix:
Gender:F
Credentials:LCSW
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 65
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-0065
Mailing Address - Country:US
Mailing Address - Phone:973-940-0116
Mailing Address - Fax:973-940-0104
Practice Address - Street 1:18 CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1756
Practice Address - Country:US
Practice Address - Phone:973-940-0116
Practice Address - Fax:973-940-0104
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055145001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical