Provider Demographics
NPI:1265148662
Name:CUSHING, VANESSA ARIEL
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ARIEL
Last Name:CUSHING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 BISCAYNE BLVD APT 2904
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2336
Mailing Address - Country:US
Mailing Address - Phone:703-475-2119
Mailing Address - Fax:
Practice Address - Street 1:244 BISCAYNE BLVD APT 2904
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2336
Practice Address - Country:US
Practice Address - Phone:703-475-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health