Paonia Psychotherapy LLC
Organization Active NPI Clinical Social Worker · Paonia, CO
NPI 1649915745 · NPPES record last updated May 3, 2022
Key facts
- NPI
- 1649915745
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- PAONIA PSYCHOTHERAPY LLC
- Practice address
- 211 Grand Ave Unit 112
Paonia, CO 81428-5093 - Phone
- (312) 912-4845
- NPI assigned
- May 3, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Lindsay Cusack, PHD LCSW
- Title
- Owner
- Phone
- (312) 912-4845
Practitioners 3
-
Christina Clouse, LPC
-
Lindsay E Cusack, PHD, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220811000271 | CO | Part B Supplier - Clinic/Group Practice | 1456734235 |
Receives reassigned benefits from 3 practitioners Practice locations: Paonia, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
211 Grand Ave Unit 112
Paonia, CO 81428-5093
Mailing address
PO Box 502
Paonia, CO 81428-0502
Phone (312) 912-4845
Other providers in Paonia, CO
- North Fork Physical Therapy and Performance
- Onarga House Assisted Living LLC
- Pam Petersen Hearing Services LLC
- Paonia Dental PC
- Paonia Investments and Associates LLC
- Pamela R Petersen
- Marian Pierce
- Amy Leigh Porter
- Mary Elizabeth Prigmore
- Jennifer Ramsey
All providers in Paonia, CO · Clinical Social Worker in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.