Healthcare Provider Details

I. General information

NPI: 1235428913
Provider Name (Legal Business Name): HEATHER LYNNE CUSUMANO B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 RAILROAD AVE
PLEASANTON CA
94566-6611
US

IV. Provider business mailing address

5925 W LAS POSITAS BLVD STE 100
PLEASANTON CA
94588-8537
US

V. Phone/Fax

Practice location:
  • Phone: 925-201-6041
  • Fax:
Mailing address:
  • Phone: 925-201-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: