Provider Demographics
NPI:1750628111
Name:BARTLE-BUSH, KELLY E (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:BARTLE-BUSH
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 1:902 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2254
Mailing Address - Country:US
Mailing Address - Phone:607-252-4519
Mailing Address - Fax:
Practice Address - Street 1:902 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2254
Practice Address - Country:US
Practice Address - Phone:607-252-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical