Provider Demographics
NPI:1154176394
Name:COUSIN, ADIA
Entity type:Individual
Prefix:
First Name:ADIA
Middle Name:
Last Name:COUSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LAUREL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4474
Mailing Address - Country:US
Mailing Address - Phone:617-821-6056
Mailing Address - Fax:
Practice Address - Street 1:10 LAUREL ST APT 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4474
Practice Address - Country:US
Practice Address - Phone:617-821-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician