Provider Demographics
NPI:1366596538
Name:CUSHMAN, SHARON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3707
Mailing Address - Country:US
Mailing Address - Phone:415-925-8511
Mailing Address - Fax:415-507-0790
Practice Address - Street 1:1021 1ST ST
Practice Address - Street 2:STE. 5
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3215
Practice Address - Country:US
Practice Address - Phone:707-745-8906
Practice Address - Fax:415-507-0790
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical