Provider Demographics
NPI:1336261536
Name:COUSINS, ANN (PHD, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:COUSINS
Suffix:
Gender:F
Credentials:PHD, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CONCORD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4047
Mailing Address - Country:US
Mailing Address - Phone:617-785-0411
Mailing Address - Fax:617-489-8068
Practice Address - Street 1:90 CONCORD AVE STE 2
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4047
Practice Address - Country:US
Practice Address - Phone:617-785-0411
Practice Address - Fax:617-489-8068
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0088566364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0559OtherBXBS OF MA