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General NPI Number Information
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NPI Number | 1407134554
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Entity Type | Organization
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Legal Business Name | DEBORA A. KUSTRON, PSY.D., LLC
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 07/22/2011
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Provider Practice Location Address
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Address Line | 61 BLOOMFIELD AVE 2ND FLOOR
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City | WINDSOR
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State | CT
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Zip | 06095-2809
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Country | US
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Telephone | 860-683-2352
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Fax |
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Provider Business Mailing Address
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Address Line | 61 BLOOMFIELD AVE 2ND FLOOR
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City | WINDSOR
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State | CT
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Zip | 06095-2809
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Country | US
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Telephone | 860-683-2352
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DEBORA A KUSTRON
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Credential | PSY.D.
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Telephone | 860-683-2352
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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 | 002140
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License Number State | CT
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