Provider Demographics
NPI:1922136977
Name:CUSICK, MARJORIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:CUSICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 EAST AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1051
Mailing Address - Country:US
Mailing Address - Phone:530-891-5571
Mailing Address - Fax:530-891-6274
Practice Address - Street 1:1068 EAST AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1051
Practice Address - Country:US
Practice Address - Phone:530-891-5571
Practice Address - Fax:530-891-6274
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist