Provider Demographics
NPI:1689358137
Name:MCCUSKER, KAYLEE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16641 SAN BENITO PL
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7830
Mailing Address - Country:US
Mailing Address - Phone:408-500-5636
Mailing Address - Fax:
Practice Address - Street 1:16641 SAN BENITO PL
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7830
Practice Address - Country:US
Practice Address - Phone:408-500-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst