Most Relevant Information
Provider Data
| NPI Number: | 1003331471 |
| Provider Name: | DENAE JUSTINE GUSTAFSON |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | 567 |
Most Important Dates
| Enumeration Date: | 08/07/2017 |
| Last Updated: | 05/19/2023 |
Provider Practice Location
110 COURT ST STE 3
CROMWELL
CT
064161273
Practice Location Phone/Fax
| Phone: | 8606139930 |
| Fax: |
Provider Mailing Location
110 COURT ST STE 3
CROMWELL
CT
064161273
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |