Active NPI
Gregory Vincent Cussen, LMSW
- Social Worker
- Portland, OR
National Provider Identifier
1295078475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M5308
- Practice address
- 3910 SE Stark St
Portland, OR 97214-3241 - Phone
- (503) 988-5501
- NPI assigned
- Apr 5, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M5308 | OR | Primary |
Addresses
Primary practice location
3910 SE Stark St
Portland, OR 97214-3241
Mailing address
3910 SE Stark St
Portland, OR 97214-3241
Phone (503) 988-5501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5308 | OR | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1295078475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3910 SE STARK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972143241",
"telephone_number": "503-988-5501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3910 SE STARK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972143241",
"telephone_number": "503-988-5501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSSEN",
"first_name": "GREGORY",
"middle_name": "VINCENT",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-05",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OR",
"license": "M5308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.