Healthcare Provider Details

I. General information

NPI: 1013467968
Provider Name (Legal Business Name): JESSICA KUSINA MARK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA KUSINA PHD

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 LORAIN ROAD SUITE 320
NORTH OLMSTED OH
44070
US

IV. Provider business mailing address

3690 CINNAMON WAY
WESTLAKE OH
44145-5700
US

V. Phone/Fax

Practice location:
  • Phone: 216-801-4656
  • Fax: 216-767-5900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: