Provider Demographics
NPI:1811285554
Name:BUSSE, WILFRIED (PHD)
Entity type:Individual
Prefix:
First Name:WILFRIED
Middle Name:
Last Name:BUSSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 HAMPDEN LN
Mailing Address - Street 2:UNIT 104
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2947
Mailing Address - Country:US
Mailing Address - Phone:301-656-0701
Mailing Address - Fax:301-656-0702
Practice Address - Street 1:4801 HAMPDEN LN
Practice Address - Street 2:UNIT 104
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2947
Practice Address - Country:US
Practice Address - Phone:301-656-0701
Practice Address - Fax:301-656-0702
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03181103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral