Provider Demographics
NPI:1568002491
Name:LUSH, ROSE ANNA (BCABA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANNA
Last Name:LUSH
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8398 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6316
Mailing Address - Country:US
Mailing Address - Phone:219-755-4049
Mailing Address - Fax:219-217-1421
Practice Address - Street 1:8398 MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6316
Practice Address - Country:US
Practice Address - Phone:219-798-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-15-04872106S00000X
IN0-21-12411106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician