Healthcare Provider Details

I. General information

NPI: 1518934884
Provider Name (Legal Business Name): CYNTHIA CLARK CUSHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S RAISINVILLE RD
MONROE MI
48161-9754
US

IV. Provider business mailing address

292 WOODHAVEN DR UNIT 9K
WHITE RIVER JUNCTION VT
05001-2834
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-7340
  • Fax:
Mailing address:
  • Phone: 413-822-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberEMC0004312
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0016850-COMP
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: