Provider Demographics
NPI:1871912543
Name:CUSACK, ERIN LYNN (LISW, SAP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:CUSACK
Suffix:
Gender:F
Credentials:LISW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PORTAGE TRAIL EXT W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3609
Mailing Address - Country:US
Mailing Address - Phone:330-929-1326
Mailing Address - Fax:330-929-1327
Practice Address - Street 1:210 PORTAGE TRAIL EXT W
Practice Address - Street 2:SUITE 101
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3609
Practice Address - Country:US
Practice Address - Phone:330-929-1326
Practice Address - Fax:330-929-1327
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1100856101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)