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NPI Code Detail

MEDICARE: DR. COURTNEY K CUSACK PSY.D

MEDICARE: DR. COURTNEY K CUSACK PSY.D
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
1103TC0700XClinical Psychologist05241MD

General Provider Information

NPI Number : 1295982122
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COURTNEY K CUSACK PSY.D
Provider Business Mailing Address
First Line : 1819 BAY RIDGE AVE STE 190
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21403-2834
Country : US
Telephone Number : 443-281-9430
Fax Number :
Provider Business Practice Location Address
First Line : 1819 BAY RIDGE AVE STE 190
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21403-2834
Country : US
Telephone Number : 443-281-9430
Fax Number : 443-782-2446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2008
Last Update Date : 05/18/2023

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