Provider Demographics
NPI:1588796015
Name:BUSHWAY, JOHN PAUL (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:BUSHWAY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PRESCOTT PL
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1829
Mailing Address - Country:US
Mailing Address - Phone:518-891-6140
Mailing Address - Fax:
Practice Address - Street 1:30 PRESCOTT PL
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1829
Practice Address - Country:US
Practice Address - Phone:518-891-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043713-11041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53712BMedicare ID - Type Unspecified