Provider Demographics
NPI:1457991184
Name:JUSINO, ADAISA
Entity Type:Individual
Prefix:
First Name:ADAISA
Middle Name:
Last Name:JUSINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1890
Mailing Address - Country:US
Mailing Address - Phone:860-296-6400
Mailing Address - Fax:
Practice Address - Street 1:221 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1890
Practice Address - Country:US
Practice Address - Phone:860-296-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral