Healthcare Provider Details

I. General information

NPI: 1740060573
Provider Name (Legal Business Name): ISABELLA ANNE CUSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 PRICE ST
DALY CITY CA
94014-2163
US

IV. Provider business mailing address

4910 KETCHUM CT
GRANITE BAY CA
95746-7245
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-3300
  • Fax:
Mailing address:
  • Phone: 916-847-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: