Provider Demographics
NPI:1154732071
Name:KUSNADI, RONY (LCPC)
Entity type:Individual
Prefix:
First Name:RONY
Middle Name:
Last Name:KUSNADI
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 CRANBROOK HILLS PL
Mailing Address - Street 2:APT G
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2755
Mailing Address - Country:US
Mailing Address - Phone:240-706-5506
Mailing Address - Fax:
Practice Address - Street 1:2324 W JOPPA RD
Practice Address - Street 2:STE 420
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4615
Practice Address - Country:US
Practice Address - Phone:240-706-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional