Provider Demographics
NPI:1689730731
Name:LUSA, MARY LOU (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY LOU
Middle Name:
Last Name:LUSA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MAYFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-3533
Mailing Address - Country:US
Mailing Address - Phone:413-746-6781
Mailing Address - Fax:413-746-6781
Practice Address - Street 1:143 SHAKER RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2786
Practice Address - Country:US
Practice Address - Phone:413-525-1711
Practice Address - Fax:413-525-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1684101YM0800X
MA636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist