Provider Demographics
NPI:1366891814
Name:BUSH, DARRIEN (MA)
Entity type:Individual
Prefix:
First Name:DARRIEN
Middle Name:
Last Name:BUSH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 TURNPIKE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2864
Mailing Address - Country:US
Mailing Address - Phone:781-344-0057
Mailing Address - Fax:
Practice Address - Street 1:1032 TURNPIKE ST STE 301
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2864
Practice Address - Country:US
Practice Address - Phone:781-344-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00407-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health