Provider Demographics
NPI:1316376866
Name:CUSHMAN, JODI (PHD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S BROADWAY STE 600
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4428
Mailing Address - Country:US
Mailing Address - Phone:914-681-9435
Mailing Address - Fax:914-231-9148
Practice Address - Street 1:34 S BROADWAY STE 600
Practice Address - Street 2:SUITE 600
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4428
Practice Address - Country:US
Practice Address - Phone:914-681-9435
Practice Address - Fax:914-231-9148
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical