Provider Demographics
NPI:1134178288
Name:CUSUMANO, JOSEPH DENNIS (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DENNIS
Last Name:CUSUMANO
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 HEMPSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8102
Mailing Address - Country:US
Mailing Address - Phone:636-493-0719
Mailing Address - Fax:
Practice Address - Street 1:701 RUE ST. FRANCOIS
Practice Address - Street 2:FLORISSANT PSYCHOLOGICAL SERVICES
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-837-7828
Practice Address - Fax:314-837-2572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21658101YM0800X
MO000043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
21658OtherNCC NATIONAL NUMBER
MO000043OtherLPC MISSOURI