Provider Demographics
NPI:1316046477
Name:BUSCH, GWENDOLYN LYNETTE (MSW)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:LYNETTE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHRIS JON CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1232
Mailing Address - Country:US
Mailing Address - Phone:203-494-9026
Mailing Address - Fax:203-773-0788
Practice Address - Street 1:660 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1969
Practice Address - Country:US
Practice Address - Phone:203-776-8390
Practice Address - Fax:203-773-0788
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker