| Debora A. Kustron, Psy.d., LLC | |
|
61 Bloomfield Ave 2nd Floor Windsor CT 06095-2809 | |
| (860) 683-2352 | |
| Not Available |
| Full Name | Debora A. Kustron, Psy.d., LLC |
|---|---|
| Speciality | Psychologist |
| Location | 61 Bloomfield Ave, Windsor, Connecticut |
| Authorized Official Name and Position | Debora a Kustron (MANAGER) |
| Authorized Official Contact | 8606832352 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Debora A. Kustron, Psy.d., LLC 61 Bloomfield Ave 2nd Floor Windsor CT 06095-2809 Ph: (860) 683-2352 | Debora A. Kustron, Psy.d., LLC 61 Bloomfield Ave 2nd Floor Windsor CT 06095-2809 Ph: (860) 683-2352 |
| NPI Number | 1407134554 |
|---|---|
| Provider Enumeration Date | 07/22/2011 |
| Last Update Date | 07/22/2011 |
| Medicare PECOS PAC ID | 0749450005 |
|---|---|
| Medicare Enrollment ID | O20110824000935 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407134554 | NPI | - | NPPES |
| 1316087950 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 002140 (Connecticut) | Primary |
| Provider Name | Debora a Kustron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316087950 PECOS PAC ID: 7911057377 Enrollment ID: I20090608000096 |
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