Provider Demographics
NPI:1356057178
Name:COUSIN, CHARITY A (CPRS)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:COUSIN
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 CRESCENT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3425
Mailing Address - Country:US
Mailing Address - Phone:781-487-1107
Mailing Address - Fax:
Practice Address - Street 1:25 N CANFIELD NILES RD STE 30
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2308
Practice Address - Country:US
Practice Address - Phone:330-542-6200
Practice Address - Fax:833-307-1913
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist