Healthcare Provider Details

I. General information

NPI: 1760832760
Provider Name (Legal Business Name): AMY ELIZABETH USTJANAUSKAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LASALLE RD STE 300
WEST HARTFORD CT
06107-2311
US

IV. Provider business mailing address

125 LASALLE RD STE 300
WEST HARTFORD CT
06107-2311
US

V. Phone/Fax

Practice location:
  • Phone: 860-777-1580
  • Fax:
Mailing address:
  • Phone: 860-777-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY33228
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number004018
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: