Provider Demographics
NPI:1720329733
Name:KUSH, MARION (LSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:
Last Name:KUSH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 BLOOMFIELD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3269
Mailing Address - Country:US
Mailing Address - Phone:814-266-5238
Mailing Address - Fax:
Practice Address - Street 1:334 BLOOMFIELD ST STE 204
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3269
Practice Address - Country:US
Practice Address - Phone:814-266-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123369104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker