Provider Demographics
NPI:1881261386
Name:DUSI, TOM ZEF (BCBA)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:ZEF
Last Name:DUSI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2424
Mailing Address - Country:US
Mailing Address - Phone:917-804-3106
Mailing Address - Fax:
Practice Address - Street 1:1887 RICHMOND AVE STE 5
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3923
Practice Address - Country:US
Practice Address - Phone:718-698-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTBCBA477246103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst