Provider Demographics
NPI:1467673921
Name:KUSENS, ILENE S (PSYD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:S
Last Name:KUSENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1085
Mailing Address - Country:US
Mailing Address - Phone:310-424-5848
Mailing Address - Fax:310-209-8456
Practice Address - Street 1:12401 WILSHIRE BLVD
Practice Address - Street 2:SUITE #306
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1085
Practice Address - Country:US
Practice Address - Phone:310-424-5848
Practice Address - Fax:310-209-8456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19463103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist