Individual
DR. KATHLEEN MAVOURNEEN CUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
135 S PROSPECT ST, YPSILANTI, MI 48198-7914
(248) 719-2845
Mailing address
21637 WELCH RD, NORTHVILLE, MI 48167-2101
(248) 719-2845
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016433
MI
Other
Enumeration date
08/27/2019
Last updated
06/04/2025
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