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General NPI Number Information
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NPI Number | 1972812832
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Entity Type | Individual
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Provider Name | LUANN CUSIC LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 405 JULIA PL
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City | SARASOTA
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State | FL
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Zip | 34236-6915
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Country | US
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Telephone | 302-388-2979
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Fax |
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Provider Business Mailing Address
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Address Line | 147 AVALINI WAY
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City | NORTH VENICE
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State | FL
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Zip | 34275-4034
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Country | US
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Telephone | 302-388-2979
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13999
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License Number State | FL
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