Provider Demographics
NPI:1407834310
Name:CUSHMAN, LAURA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
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:PO BOX 664
Mailing Address - Street 2:601 ELMWOOD AVENUE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-3271
Mailing Address - Fax:585-442-2949
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3271
Practice Address - Fax:585-442-2949
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008373-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA7172Medicare UPIN
RA7172Medicare ID - Type Unspecified
NYRB0717Medicare PIN