Provider Demographics
NPI:1396960720
Name:BUSTAMANTE, EDUARDO M (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:M
Last Name:BUSTAMANTE
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9760
Mailing Address - Country:US
Mailing Address - Phone:413-203-1450
Mailing Address - Fax:
Practice Address - Street 1:235 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5123
Practice Address - Country:US
Practice Address - Phone:413-532-0389
Practice Address - Fax:413-534-3238
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical