Individual
DR. SAMUEL DAVID LUSTGARTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
702 N BLACKHAWK AVE STE 205, MADISON, WI 53705-3357
(720) 260-4362
(971) 999-0817
Mailing address
702 N BLACKHAWK AVE STE 205, MADISON, WI 53705-3357
(720) 260-4362
(971) 999-0817
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
3178
OR
103TC1900X
Counseling Psychologist
Primary
3717-57
WI
Other
Enumeration date
10/28/2019
Last updated
12/29/2022
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