Provider Demographics
NPI:1750820254
Name:J. CUSAAC, INC.
Entity Type:Organization
Organization Name:J. CUSAAC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUSAAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-445-9220
Mailing Address - Street 1:11085 HARBOUR SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428
Mailing Address - Country:US
Mailing Address - Phone:561-445-9220
Mailing Address - Fax:
Practice Address - Street 1:11085 HARBOUR SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1244
Practice Address - Country:US
Practice Address - Phone:561-445-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018571500Medicaid
FL12759738OtherCIGNA