Provider Demographics
NPI:1679775969
Name:ARCHIBOLD - BUGETT, ADINA AMARA
Entity type:Individual
Prefix:MRS
First Name:ADINA
Middle Name:AMARA
Last Name:ARCHIBOLD - BUGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ADINA
Other - Middle Name:AMARA
Other - Last Name:ARCHIBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 WINDMILL PARKWAY
Mailing Address - Street 2:912
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1329 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3211
Practice Address - Country:US
Practice Address - Phone:718-337-6800
Practice Address - Fax:718-337-0940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NV8212-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker