Healthcare Provider Details

I. General information

NPI: 1356868525
Provider Name (Legal Business Name): CARA MCCUSKER LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 DRUMMOND RD
PHILADELPHIA PA
19154-3807
US

IV. Provider business mailing address

3557 BROOKVIEW RD
PHILADELPHIA PA
19154-4035
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-7625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH003432
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: