Provider Demographics
NPI:1477257855
Name:BUSH, ANITA M
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:M
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 1:3842 HARLEM RD STE 400-129
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1935
Mailing Address - Country:US
Mailing Address - Phone:716-370-5986
Mailing Address - Fax:
Practice Address - Street 1:330 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1868
Practice Address - Country:US
Practice Address - Phone:716-335-7108
Practice Address - Fax:716-842-0668
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health