Provider Demographics
NPI:1770796492
Name:JOSIE CUSMA LLC
Entity type:Organization
Organization Name:JOSIE CUSMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSMA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW
Authorized Official - Phone:262-785-2776
Mailing Address - Street 1:634 MILWAUKEE ST.
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-0680
Mailing Address - Country:US
Mailing Address - Phone:262-646-6280
Mailing Address - Fax:262-646-6284
Practice Address - Street 1:13965 W BURLEIGH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3074
Practice Address - Country:US
Practice Address - Phone:262-785-2776
Practice Address - Fax:262-785-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty