Healthcare Provider Details

I. General information

NPI: 1457759367
Provider Name (Legal Business Name): MARY LUSSIER-CUSHING RN/PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9137
  • Fax: 617-724-9560
Mailing address:
  • Phone: 617-724-9137
  • Fax: 617-724-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN133921
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: