Healthcare Provider Details

I. General information

NPI: 1568366201
Provider Name (Legal Business Name): LUMARE PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
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 TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AMY E USTJANAUSKAS
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 860-777-1580