Provider Demographics
NPI:1134973605
Name:ASARISI, JOSEPH EDGAR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDGAR
Last Name:ASARISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHELLEY ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1905
Mailing Address - Country:US
Mailing Address - Phone:860-316-6882
Mailing Address - Fax:
Practice Address - Street 1:9 SHELLEY ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1905
Practice Address - Country:US
Practice Address - Phone:860-316-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT249422840106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician