1790859353 NPI number — JOSIE CUSMA MSW,LCSW

Table of content: JOSIE CUSMA MSW,LCSW (NPI 1790859353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790859353 NPI number — JOSIE CUSMA MSW,LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUSMA
Provider First Name:
JOSIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW,LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790859353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N87W16462 JACOBSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-255-1040
Provider Business Mailing Address Fax Number:
262-255-4090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13965 W BURLEIGH RD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-785-2776
Provider Business Practice Location Address Fax Number:
262-785-2773
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6588-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6588-123 . This is a "LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com