Provider Demographics
NPI:1568947778
Name:CUSHMAN, CAROL LYNNE (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNNE
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 87TH ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1126
Mailing Address - Country:US
Mailing Address - Phone:212-369-3074
Mailing Address - Fax:
Practice Address - Street 1:125 E 87TH ST APT 5D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1126
Practice Address - Country:US
Practice Address - Phone:212-369-3074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR-017779-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical