Provider Demographics
NPI:1386125276
Name:CUSIMANO, CHRISTA
Entity type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:
Last Name:CUSIMANO
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 1:1926 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1446
Mailing Address - Country:US
Mailing Address - Phone:716-860-2937
Mailing Address - Fax:
Practice Address - Street 1:24411 AMADOR ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1301
Practice Address - Country:US
Practice Address - Phone:510-784-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool