Provider Demographics
NPI:1538499777
Name:BUSCH, ELSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:BUSCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2629
Mailing Address - Country:US
Mailing Address - Phone:626-321-4789
Mailing Address - Fax:626-698-1155
Practice Address - Street 1:1420 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108
Practice Address - Country:US
Practice Address - Phone:626-321-4789
Practice Address - Fax:626-698-1155
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22979103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral