Provider Demographics
NPI:1851512081
Name:BUSH, ALYSSA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:MARIE
Last Name:BUSH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CENTRAL ST # 1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5826
Mailing Address - Country:US
Mailing Address - Phone:978-283-0296
Mailing Address - Fax:978-283-2665
Practice Address - Street 1:298 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-283-0296
Practice Address - Fax:978-283-2665
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health