Provider Demographics
NPI:1457070658
Name:BUSH, NIYA LYNN
Entity Type:Individual
Prefix:MRS
First Name:NIYA
Middle Name:LYNN
Last Name:BUSH
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 1:59 HEWLET LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1725
Mailing Address - Country:US
Mailing Address - Phone:609-346-8822
Mailing Address - Fax:
Practice Address - Street 1:6102 HAMILTON WAY
Practice Address - Street 2:
Practice Address - City:EASTAMPTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08060-1673
Practice Address - Country:US
Practice Address - Phone:484-515-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional