Provider Demographics
NPI:1700489945
Name:CUSICK, CHELSEA RAE (LSW)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:RAE
Last Name:CUSICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 LOPER RD
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16130-2520
Mailing Address - Country:US
Mailing Address - Phone:724-815-8395
Mailing Address - Fax:
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1559
Practice Address - Country:US
Practice Address - Phone:814-844-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker