Provider Demographics
NPI:1780168104
Name:LUSH, JULIEANNE (MS)
Entity type:Individual
Prefix:
First Name:JULIEANNE
Middle Name:
Last Name:LUSH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WINTERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4842
Mailing Address - Country:US
Mailing Address - Phone:585-290-1574
Mailing Address - Fax:
Practice Address - Street 1:5130 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-394-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health