Provider Demographics
NPI:1629010913
Name:LUSA, JENNIFER V (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:V
Last Name:LUSA
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 1:78 EASTERN BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4325
Mailing Address - Country:US
Mailing Address - Phone:860-652-0428
Mailing Address - Fax:860-652-0081
Practice Address - Street 1:78 EASTERN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4325
Practice Address - Country:US
Practice Address - Phone:860-652-0428
Practice Address - Fax:860-652-0081
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004754OtherLCSW CT LICENSE #