Healthcare Provider Details

I. General information

NPI: 1215883392
Provider Name (Legal Business Name): CHERISH BURRUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2666 STATE ST
NEW HAVEN CT
06517-2232
US

IV. Provider business mailing address

41 LODGE ST
NEW HAVEN CT
06515-1063
US

V. Phone/Fax

Practice location:
  • Phone: 860-544-0356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: