Provider Demographics
NPI:1528242815
Name:MANCUSO, ROBERT A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:HANCOCK COUNTY BOARD OF EDUCATION
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-1300
Mailing Address - Country:US
Mailing Address - Phone:304-564-3411
Mailing Address - Fax:304-564-3990
Practice Address - Street 1:104 N COURT ST
Practice Address - Street 2:HANCOCK COUNTY BOARD OF EDUCATION
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047
Practice Address - Country:US
Practice Address - Phone:304-564-3411
Practice Address - Fax:304-564-3990
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist