Provider Demographics
NPI:1437037140
Name:COUSINO, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COUSINO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2038
Mailing Address - Country:US
Mailing Address - Phone:419-724-1500
Mailing Address - Fax:
Practice Address - Street 1:5734 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2038
Practice Address - Country:US
Practice Address - Phone:419-724-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2512821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker