Provider Demographics
NPI:1518725829
Name:MARTUSCELLO, JENNA (MA, CAS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MARTUSCELLO
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CHESTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-5210
Mailing Address - Country:US
Mailing Address - Phone:607-346-3486
Mailing Address - Fax:
Practice Address - Street 1:306 CHESTERFIELD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-5210
Practice Address - Country:US
Practice Address - Phone:607-346-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool