Provider Demographics
NPI:1497139968
Name:LUSENHOP, EMILY
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:LUSENHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 STATE ST
Mailing Address - Street 2:PO BOX 797
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3751
Mailing Address - Country:US
Mailing Address - Phone:207-871-7431
Mailing Address - Fax:
Practice Address - Street 1:66 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3751
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC153221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical