Healthcare Provider Details

I. General information

NPI: 1932558442
Provider Name (Legal Business Name): THOMAS NICHOLAS SHUSTERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MAIN ST
EAST HARTFORD CT
06108-3142
US

IV. Provider business mailing address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax:
Mailing address:
  • Phone: 860-610-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number010408
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: