Provider Demographics
NPI:1912121666
Name:CUSACK, LINDSAY E (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:E
Last Name:CUSACK
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-0502
Mailing Address - Country:US
Mailing Address - Phone:773-485-1230
Mailing Address - Fax:
Practice Address - Street 1:211 GRAND AVENUE, STE 114
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428-0502
Practice Address - Country:US
Practice Address - Phone:312-912-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0103931041C0700X
CO099243091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical