Provider Demographics
NPI:1003449414
Name:CUSACK APPLIED BEHAVIOR ANALYSIS
Entity Type:Organization
Organization Name:CUSACK APPLIED BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER CEO
Authorized Official - Phone:203-885-9122
Mailing Address - Street 1:1 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3012
Mailing Address - Country:US
Mailing Address - Phone:203-885-9122
Mailing Address - Fax:203-546-8163
Practice Address - Street 1:1 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-3012
Practice Address - Country:US
Practice Address - Phone:203-885-9122
Practice Address - Fax:203-546-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty