Active NPI
Darlene Gustavson, PSYD
- Clinical Psychologist
- Manchester, NH
National Provider Identifier
1336111475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1115
- Practice address
- 814 Elm St
Suite 515
Manchester, NH 03101-2130 - Phone
- (603) 703-2900
- NPI assigned
- Feb 2, 2006
- Last updated
- May 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY6867 | FL | |
| Clinical Psychologist | 103TC0700X | 1115 | NH | Primary |
Addresses
Primary practice location
814 Elm St
Suite 515
Manchester, NH 03101-2130
Mailing address
814 Elm St
Suite 515
Manchester, NH 03101-2130
Phone (603) 703-2900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1115 | NH | MD | Addiction (Substance Use Disorder) Counselor |
| PY6867 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1336111475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 ELM ST",
"address_2": "SUITE 515",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031012130",
"telephone_number": "603-703-2900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "814 ELM ST",
"address_2": "SUITE 515",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031012130",
"telephone_number": "603-703-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAVSON",
"first_name": "DARLENE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-02",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY6867",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NH",
"license": "1115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.