Provider Demographics
NPI:1568455202
Name:BUSCH, LEWISE L (PHD)
Entity type:Individual
Prefix:DR
First Name:LEWISE
Middle Name:L
Last Name:BUSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4125 36TH ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1805
Mailing Address - Country:US
Mailing Address - Phone:202-543-4645
Mailing Address - Fax:202-543-4476
Practice Address - Street 1:530 7TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2768
Practice Address - Country:US
Practice Address - Phone:202-543-4645
Practice Address - Fax:202-543-4476
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1527103TC0700X
VA0810002292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPSR1527OtherPSYCHOLOGY LICENSE
VA0810002292OtherCLINICAL PSYCHOLOGY LICEN
VA0810002292OtherCLINICAL PSYCHOLOGY LICEN