Individual
AMY CUSUMANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3151 AIRWAY AVE, D-1, COSTA MESA, CA 92626-4607
(714) 957-8229
Mailing address
3151 AIRWAY AVE, D-1, COSTA MESA, CA 92626-4607
(714) 957-8229
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C4970811
CA
Other
Enumeration date
06/29/2015
Last updated
06/29/2015
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