Provider Demographics
NPI:1235104381
Name:YOUSIK, MARCIA A (RN CS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:YOUSIK
Suffix:
Gender:F
Credentials:RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425789
Mailing Address - Street 2:MEDICAL E23-395
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-0015
Mailing Address - Country:US
Mailing Address - Phone:617-253-0216
Mailing Address - Fax:
Practice Address - Street 1:77 MASS AVE
Practice Address - Street 2:MEDICAL E23-395
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4301
Practice Address - Country:US
Practice Address - Phone:617-253-0216
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104105364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0092OtherBLUE CROSS
MAPN0092OtherBLUE CROSS
MANS0677Medicare ID - Type Unspecified