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General NPI Number Information
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NPI Number | 1336111475
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Entity Type | Individual
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Provider Name | DARLENE GUSTAVSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 814 ELM ST SUITE 515
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City | MANCHESTER
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State | NH
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Zip | 03101-2130
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Country | US
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Telephone | 603-703-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 814 ELM ST SUITE 515
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City | MANCHESTER
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State | NH
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Zip | 03101-2130
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Country | US
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Telephone | 603-703-2900
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6867
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1115
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License Number State | NH
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