Provider Demographics
NPI:1619161486
Name:BUSCH, ERIKA C (PSYD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:C
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 1:127 WEST STATE ST. FIRST FLOOR
Mailing Address - Street 2:FAMILY & CHILDREN'S SERVICE OF ITHACA
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5427
Mailing Address - Country:US
Mailing Address - Phone:607-273-7494
Mailing Address - Fax:607-273-7484
Practice Address - Street 1:127 WEST STATE ST. FIRST FLOOR
Practice Address - Street 2:FAMILY & CHILDREN'S SERVICE OF ITHACA
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5427
Practice Address - Country:US
Practice Address - Phone:607-273-7494
Practice Address - Fax:607-273-7484
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY843476Medicaid
1124176680OtherAGENCY NPI #
NY39703AMedicare PIN