Provider Demographics
NPI:1275970667
Name:LASUSA, JENENE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JENENE
Middle Name:L
Last Name:LASUSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 QUINSEY LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1289
Mailing Address - Country:US
Mailing Address - Phone:847-387-0080
Mailing Address - Fax:
Practice Address - Street 1:135 E VAN EMMON ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1581
Practice Address - Country:US
Practice Address - Phone:847-387-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0143111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical