Provider Demographics
NPI:1154844280
Name:LUSETTI, JENNIFER R (QMHS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:LUSETTI
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023
Mailing Address - Country:US
Mailing Address - Phone:740-618-2322
Mailing Address - Fax:740-618-2324
Practice Address - Street 1:594 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023
Practice Address - Country:US
Practice Address - Phone:740-618-2322
Practice Address - Fax:740-618-2324
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical