Provider Demographics
NPI:1831232867
Name:MANETTI-CUSA, JULIAN L (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:L
Last Name:MANETTI-CUSA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4102
Mailing Address - Country:US
Mailing Address - Phone:917-593-5367
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE STE 508
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7791
Practice Address - Country:US
Practice Address - Phone:917-593-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist