Provider Demographics
NPI:1740489749
Name:COUSINO, LINDA L (LSW,)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:COUSINO
Suffix:
Gender:F
Credentials:LSW,
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:COUSINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCC
Mailing Address - Street 1:4913 HARROUN RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2197
Mailing Address - Country:US
Mailing Address - Phone:419-870-8763
Mailing Address - Fax:419-870-8763
Practice Address - Street 1:4913 HARROUN RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2197
Practice Address - Country:US
Practice Address - Phone:419-870-8763
Practice Address - Fax:419-870-8763
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-00104531041C0700X
OHE0010453101YP2500X
MI6401009026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical