Provider Demographics
NPI:1780299784
Name:BUSHMAN, ADRAEL ASAI (LCSW)
Entity type:Individual
Prefix:
First Name:ADRAEL
Middle Name:ASAI
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ADRAEL
Other - Middle Name:ASAI
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4535 SOUTHWESTERN BLVD STE 802
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1860
Mailing Address - Country:US
Mailing Address - Phone:716-201-0442
Mailing Address - Fax:
Practice Address - Street 1:4535 SOUTHWESTERN BLVD STE 802
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-201-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0971111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical