Provider Demographics
NPI:1518244730
Name:BUSCH, ANDREA DANIELLE (BCABA, ITDS)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DANIELLE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:BCABA, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 SUNBURY CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4731
Mailing Address - Country:US
Mailing Address - Phone:239-250-1605
Mailing Address - Fax:
Practice Address - Street 1:5041 SUNBURY CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4731
Practice Address - Country:US
Practice Address - Phone:239-250-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0020459103K00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0020459OtherBEHAVIOR ANALYST CERTIFICATION BOARD