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General NPI Number Information
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NPI Number | 1194333823
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH LUSSIER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 15 PRESTON RD
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City | TERRYVILLE
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State | CT
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Zip | 06786-4209
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Country | US
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Telephone | 860-940-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PRESTON RD
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City | TERRYVILLE
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State | CT
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Zip | 06786-4209
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Country | US
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Telephone | 860-940-0321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 002173
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License Number State | CT
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