Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 1344 | KY |
N | 102L00000X | Psychologist | 1344 | KY |
N | 103T00000X | Psychologist | 1344 | KY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1344 | KY |
Y | 103G00000X | Clinical Psychologist | 1344 | KY |
Y | 103TC0700X | Clinical Psychologist | 1344 | KY |
N | 103TC1900X | Counseling Psychologist | 1344 | KY |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1344 | KY |
NPI | 1215239801 |
---|---|
Provider Name | Dr. Gary Matthew Cusick |
First Address | Louisville, KY 40222-6616 |
Second Address | Louisville, KY 40222-6616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2010 |
Last Update Date | 04/10/2012 |