Individual
MS. LORI A USTICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BOC ABC CERTIFIED
Contact information
Practice address
170 RAILROAD ST, CANAAN, CT 06018-2011
(860) 824-7510
(866) 686-1517
Mailing address
170 RAILROAD ST, CANAAN, CT 06018-2011
(860) 824-7510
(866) 686-1517
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
D16532 BOC
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12DME0614CT01
BLUE CROSS PROVIDER NUMBE
CT
01
—
2733042
AETNA PROVIDER NUMBER
CT
Enumeration date
03/14/2007
Last updated
07/09/2007
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