Provider Demographics
NPI:1205909694
Name:MCDONOUGH-BUSA, SHARON MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:MCDONOUGH-BUSA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:190 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3416
Mailing Address - Country:US
Mailing Address - Phone:781-769-8670
Mailing Address - Fax:781-769-6717
Practice Address - Street 1:190 LENOX ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3416
Practice Address - Country:US
Practice Address - Phone:781-769-8670
Practice Address - Fax:781-769-6717
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10202341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical