Provider Demographics
NPI:1649460064
Name:KUSMIERSKI, TONI LYN (LCSW)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:LYN
Last Name:KUSMIERSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9579 BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NY
Mailing Address - Zip Code:14005-9774
Mailing Address - Country:US
Mailing Address - Phone:716-474-1561
Mailing Address - Fax:
Practice Address - Street 1:27 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1001
Practice Address - Country:US
Practice Address - Phone:585-658-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0788901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical