Individual
DR. DEBRA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1011 VETERANS MEMORIAL PKWY, BRADLEY HOSPITAL, RIVERSIDE, RI 02915-5061
(401) 432-1000
Mailing address
1011 VETERANS MEMORIAL PKWY, BRADLEY HOSPITAL, RIVERSIDE, RI 02915-5061
(401) 432-1000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
9065
MA
103TC2200X
Clinical Child & Adolescent Psychologist
9065
MA
Other
Enumeration date
02/07/2008
Last updated
09/26/2011
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