Provider Demographics
NPI:1952406480
Name:BUSILLO, BARBARA ADELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ADELIA
Last Name:BUSILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5638
Mailing Address - Country:US
Mailing Address - Phone:718-498-5555
Mailing Address - Fax:718-498-6868
Practice Address - Street 1:887 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1309
Practice Address - Country:US
Practice Address - Phone:718-467-6441
Practice Address - Fax:718-498-6868
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP062830-11041C0700X
NY000628301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244931Medicaid
NYN240G1Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY00244931Medicaid