Provider Demographics
NPI:1720671506
Name:BUSHINSKI, KAITLIN ANN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:BUSHINSKI
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 1:97 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2713
Mailing Address - Country:US
Mailing Address - Phone:570-604-1622
Mailing Address - Fax:
Practice Address - Street 1:97 WEAVER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2713
Practice Address - Country:US
Practice Address - Phone:570-604-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0216381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical