Provider Demographics
NPI:1073700779
Name:CUSI, ANNALISA R (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:R
Last Name:CUSI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-364-9700
Mailing Address - Fax:718-365-3670
Practice Address - Street 1:2432 GRAND CONCOURSE
Practice Address - Street 2:SUITE 505
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:718-364-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073906-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245029Medicaid