Provider Demographics
NPI:1770608960
Name:BUSSE, WILMA J (EDD)
Entity type:Individual
Prefix:DR
First Name:WILMA
Middle Name:J
Last Name:BUSSE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4143
Mailing Address - Country:US
Mailing Address - Phone:978-282-4503
Mailing Address - Fax:
Practice Address - Street 1:73 TREMONT ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3916
Practice Address - Country:US
Practice Address - Phone:617-573-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4677103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4677OtherPSYCH. LICENSE