Provider Demographics
NPI:1932580669
Name:FLORES-BUSH, LIDIA E (LMFT)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:E
Last Name:FLORES-BUSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:E
Other - Last Name:FLORES MONTALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3810 23RD AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1964
Mailing Address - Country:US
Mailing Address - Phone:718-513-8169
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY
Practice Address - Street 2:SUITE807
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6008
Practice Address - Country:US
Practice Address - Phone:718-513-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000998-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist