Basic Information
| Provider Information | |||||||||
| NPI: | 1174640668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 156 W 56TH ST STE 1804 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100193878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518100 | ||||||||
| FaxNumber: | 8889772547 | ||||||||
| Practice Location | |||||||||
| Address1: | 290 HAWKINS AVE | ||||||||
| Address2: | STE. B | ||||||||
| City: | LAKE RONKONKOMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117799600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314311581 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 013045 | NY | N | Behavioral Health & Social Service Providers | Psychologist | 103TC2200X | 013045 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | 013045 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.