Healthcare Provider Details

I. General information

NPI: 1013827054
Provider Name (Legal Business Name): FAE CUSHING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HUDSON ST FL 21
JERSEY CITY NJ
07302-3929
US

IV. Provider business mailing address

101 HUDSON ST
JERSEY CITY NJ
07302-3915
US

V. Phone/Fax

Practice location:
  • Phone: 201-896-7171
  • Fax:
Mailing address:
  • Phone: 201-896-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01306600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: