Individual
MS. PATRICIA GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
700 MASSACHUSETTS AVE, CAMBRIDGE, MA 02139-3345
(718) 299-3045
Mailing address
700 MASSACHUSETTS AVE, CAMBRIDGE, MA 02139-3345
(888) 500-2067
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
096648
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355940
—
NY
01
—
1285628552
AGENCIES
NY
01
—
WVE061
MEDICARE #
NY
Enumeration date
01/07/2016
Last updated
06/10/2024
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