| Doctor Name: | DALE MYRA TUSHMAN |
| NPI Number: | 1013960004 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | CSW 001945 |
| Business Practice Address: | 1000 Commissioner Dr Darien, GA - 313059487 |
| Business Phone Number: | 9124379300 |
| Business Fax Number: | 9124379481 |
| Mailing Address: | 3045 Scarlett St, BRUNSWICK |
| State: | GA |
| Postal Code: | 315201251 |
| Phone Number: | 9125548534 |
| Fax Number: | 9122901448 |
| NPI Enumeration Date: | 05/18/2006 |
| NPI Last Update Date: | 10/01/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CSW 001945 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |