Provider Demographics
NPI:1639274244
Name:CUSICK, BETHANY LEE (MSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LEE
Last Name:CUSICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:LEE
Other - Last Name:TOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:453 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1462
Mailing Address - Country:US
Mailing Address - Phone:774-553-5391
Mailing Address - Fax:
Practice Address - Street 1:453 FRONT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1462
Practice Address - Country:US
Practice Address - Phone:774-553-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist