Provider Demographics
NPI:1528194271
Name:COUSINS, ANDREA B (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:B
Last Name:COUSINS
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 MAIN ST
Mailing Address - Street 2:SUITE 303-304
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3264
Mailing Address - Country:US
Mailing Address - Phone:413-584-8635
Mailing Address - Fax:
Practice Address - Street 1:182 MAIN ST
Practice Address - Street 2:SUITE 303-304
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3264
Practice Address - Country:US
Practice Address - Phone:413-584-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY211819OtherMANAGED HEALTH NETWORK
MAWO 4992OtherBLUE CROSS BLUE SHIELD
MA760874OtherTUFTS HEALTH PLAN
MA760874OtherTUFTS HEALTH PLAN
MA0007680349Medicare UPIN