Provider Demographics
NPI:1750450292
Name:FUSARO, PH.D., LOUIS A (PHD, CGP)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:A
Last Name:FUSARO, PH.D.
Suffix:
Gender:M
Credentials:PHD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BROOKLINE ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4057
Mailing Address - Country:US
Mailing Address - Phone:781-444-6286
Mailing Address - Fax:781-449-3092
Practice Address - Street 1:4 OAK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2460
Practice Address - Country:US
Practice Address - Phone:781-449-3092
Practice Address - Fax:781-449-3092
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA483103TM1800X, 103T00000X, 103TP2701X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891171Medicaid
MA1891171Medicaid