Provider Demographics
NPI:1811484546
Name:CUSICK, CYNTHIA JANE (NE LIMHP 1186 90 289)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JANE
Last Name:CUSICK
Suffix:
Gender:F
Credentials:NE LIMHP 1186 90 289
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 EAST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025
Mailing Address - Country:US
Mailing Address - Phone:402-917-2570
Mailing Address - Fax:
Practice Address - Street 1:748 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025
Practice Address - Country:US
Practice Address - Phone:402-917-2570
Practice Address - Fax:402-941-7018
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP90104100000X
NECMSW289104100000X
NELIMHP1186104100000X
IACISW7081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker