Provider Demographics
NPI:1487219598
Name:BUSH, CHRISTY A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:A
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:A
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:22919 MERRICK BLVD # 710
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2108
Mailing Address - Country:US
Mailing Address - Phone:267-225-8763
Mailing Address - Fax:
Practice Address - Street 1:17 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5701
Practice Address - Country:US
Practice Address - Phone:516-459-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0950131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical