Provider Demographics
NPI:1811386097
Name:BUSHMAN, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 LOWER WESTFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2744
Mailing Address - Country:US
Mailing Address - Phone:413-505-8914
Mailing Address - Fax:
Practice Address - Street 1:98 LOWER WESTFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2744
Practice Address - Country:US
Practice Address - Phone:413-505-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No253Z00000XAgenciesIn Home Supportive Care