Provider Demographics
NPI:1497588552
Name:BUSCEMI, NICOLE (LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BUSCEMI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 E BROADWAY BLVD STE A200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3903
Mailing Address - Country:US
Mailing Address - Phone:520-327-1529
Mailing Address - Fax:
Practice Address - Street 1:55 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1857
Practice Address - Country:US
Practice Address - Phone:520-452-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-16146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist