Provider Demographics
NPI:1659988822
Name:CUSUMANO, KATHERINE BEUS (APCC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BEUS
Last Name:CUSUMANO
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11975 N DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9425
Mailing Address - Country:US
Mailing Address - Phone:209-200-5266
Mailing Address - Fax:
Practice Address - Street 1:11975 N DAVIS RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9425
Practice Address - Country:US
Practice Address - Phone:209-200-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC8125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional