Healthcare Provider Details

I. General information

NPI: 1063836997
Provider Name (Legal Business Name): GEOFFREY CUSHNER M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GROVE ST STE LL11
WORCESTER MA
01605-2677
US

IV. Provider business mailing address

108 GROVE ST STE LL11
WORCESTER MA
01605-2677
US

V. Phone/Fax

Practice location:
  • Phone: 508-304-7499
  • Fax: 774-420-7255
Mailing address:
  • Phone: 508-304-7499
  • Fax: 774-420-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: