Provider Demographics
NPI:1316108855
Name:BUSE, GINA (PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:BUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 SW ALLAPATTAH RD
Mailing Address - Street 2:
Mailing Address - City:INDIANTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34956-4307
Mailing Address - Country:US
Mailing Address - Phone:772-597-9400
Mailing Address - Fax:772-597-9498
Practice Address - Street 1:96 SW ALLAPATTAH RD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-4307
Practice Address - Country:US
Practice Address - Phone:772-597-9400
Practice Address - Fax:772-597-9498
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical