Provider Demographics
NPI:1902004880
Name:STEVERSON-BUSH, CATHERINE DENISE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DENISE
Last Name:STEVERSON-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 1:3632 CLAYTON RD
Mailing Address - Street 2:NO. 201
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-5186
Mailing Address - Country:US
Mailing Address - Phone:925-825-2764
Mailing Address - Fax:925-825-2764
Practice Address - Street 1:111 MYRTLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2525
Practice Address - Country:US
Practice Address - Phone:510-839-3800
Practice Address - Fax:510-839-3888
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist