MEDICARE: CARLA MARIA CANUSO M.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
1	2084P0800X	Psychiatry Physician	81213	MA

General Provider Information

NPI Number	:	1952348914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA MARIA CANUSO M.D.

Provider Business Mailing Address
First Line	:	19 CORYELL ST
Second Line	:
City	:	LAMBERTVILLE
State	:	NJ
Zip	:	08530-1706
Country	:	US
Telephone Number	:	609-730-7732
Fax Number	:

Provider Business Practice Location Address
First Line	:	JANSSEN PHARMACEUTICALS
Second Line	:
City	:	TITUSVILLE
State	:	NJ
Zip	:	08560
Country	:	US
Telephone Number	:	609-730-7732
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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