Provider Demographics
NPI:1669147658
Name:QUERAISHI, BUSHRA N
Entity type:Individual
Prefix:
First Name:BUSHRA
Middle Name:N
Last Name:QUERAISHI
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 1:12705 BRIGHT SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4130
Mailing Address - Country:US
Mailing Address - Phone:240-441-8703
Mailing Address - Fax:
Practice Address - Street 1:12705 BRIGHT SPRING WAY
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-4130
Practice Address - Country:US
Practice Address - Phone:240-441-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27514104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker