Provider Demographics
NPI:1891553590
Name:BUSCH, AMY HELENA (LADC 1, MED)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HELENA
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LADC 1, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NEPONSET AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3432
Mailing Address - Country:US
Mailing Address - Phone:617-823-6301
Mailing Address - Fax:
Practice Address - Street 1:23 NEPONSET AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-3432
Practice Address - Country:US
Practice Address - Phone:617-823-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty