MEDICARE: MRS. TAMIKA A COUSAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1295667285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMIKA A COUSAR

Provider Business Mailing Address
First Line	:	991 MYRTLE AVE APT 7C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6619
Country	:	US
Telephone Number	:	917-795-5974
Fax Number	:

Provider Business Practice Location Address
First Line	:	991 MYRTLE AVE APT 7C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6619
Country	:	US
Telephone Number	:	917-795-5974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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