Provider Demographics
NPI:1760640916
Name:BUSH, MELANIE DARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:DARLENE
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WEST ST
Mailing Address - Street 2:CARTHAGE AREA HOSPITAL
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-9703
Mailing Address - Country:US
Mailing Address - Phone:315-493-5080
Mailing Address - Fax:315-493-5082
Practice Address - Street 1:36500 RTE 26
Practice Address - Street 2:CARTHAGE CENTRAL HIGH SCHOOL-SCHOOL BASED HEALTH CLINIC
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9506
Practice Address - Country:US
Practice Address - Phone:315-493-5080
Practice Address - Fax:315-493-5082
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078262104100000X
NY0807391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker