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General NPI Number Information
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NPI Number | 1912121666
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Entity Type | Individual
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Provider Name | LINDSAY E CUSACK PHD, LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 211 GRAND AVENUE, STE 114
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City | PAONIA
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State | CO
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Zip | 81428-0502
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Country | US
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Telephone | 312-912-4845
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 502
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City | PAONIA
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State | CO
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Zip | 81428-0502
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Country | US
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Telephone | 773-485-1230
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Fax |
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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 | 149-010393
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09924309
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License Number State | CO
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