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General NPI Number Information
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NPI Number | 1740489749
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Entity Type | Individual
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Provider Name | LINDA L COUSINO LSW,
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 11/08/2008
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Provider Practice Location Address
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Address Line | 4913 HARROUN RD
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City | SYLVANIA
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State | OH
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Zip | 43560-2197
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Country | US
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Telephone | 419-870-8763
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Fax | 419-870-8763
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Provider Business Mailing Address
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Address Line | 4913 HARROUN RD
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City | SYLVANIA
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State | OH
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Zip | 43560-2197
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Country | US
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Telephone | 419-870-8763
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Fax | 419-870-8763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S-0010453
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0010453
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401009026
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License Number State | MI
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