Individual
DR. GARY MATTHEW CUSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1206 HOLSWORTH LN, LOUISVILLE, KY 40222-6616
(502) 439-0398
Mailing address
1206 HOLSWORTH LANE, LOUISVILLE, KY 40222-6616
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1344
KY
103T00000X
Psychologist
1344
KY
103TB0200X
Cognitive & Behavioral Psychologist
1344
KY
103TC0700X
Clinical Psychologist
Primary
1344
KY
103TC1900X
Counseling Psychologist
1344
KY
103TM1800X
Intellectual & Developmental Disabilities Psychologist
1344
KY
Other
Enumeration date
12/02/2010
Last updated
10/04/2012
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