Provider Demographics
NPI:1285911776
Name:KUSCH, STEPHEN CHARLES (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHARLES
Last Name:KUSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 OCEAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1532
Mailing Address - Country:US
Mailing Address - Phone:510-601-7129
Mailing Address - Fax:
Practice Address - Street 1:5605 OCEAN VIEW DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1532
Practice Address - Country:US
Practice Address - Phone:510-601-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist