Provider Demographics
NPI:1659512648
Name:BUGGE, DAVIA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAVIA
Middle Name:S
Last Name:BUGGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2913
Mailing Address - Country:US
Mailing Address - Phone:845-623-7782
Mailing Address - Fax:845-623-0648
Practice Address - Street 1:6 SMITH ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2913
Practice Address - Country:US
Practice Address - Phone:845-623-7782
Practice Address - Fax:845-623-0648
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07632411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical