Individual
AUDREY FAITH CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
591 CENTRE ST, BROCKTON, MA 02302-3326
(774) 315-4929
Mailing address
911 EAST ST, DEDHAM, MA 02026-6301
(781) 708-1056
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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