Provider Demographics
NPI:1528591146
Name:BUSUTTIL, JAMI (LCAT)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:
Last Name:BUSUTTIL
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 TWILIGHT LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4424
Mailing Address - Country:US
Mailing Address - Phone:516-729-8283
Mailing Address - Fax:
Practice Address - Street 1:389 TWILIGHT LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4424
Practice Address - Country:US
Practice Address - Phone:516-729-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001536221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist