Provider Demographics
NPI:1295982122
Name:CUSACK, COURTNEY K (PSYD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:K
Last Name:CUSACK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:N
Other - Last Name:COMPAGNONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1819 BAY RIDGE AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2834
Mailing Address - Country:US
Mailing Address - Phone:443-281-9430
Mailing Address - Fax:
Practice Address - Street 1:1819 BAY RIDGE AVE STE 190
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2834
Practice Address - Country:US
Practice Address - Phone:443-281-9430
Practice Address - Fax:443-782-2446
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical