Provider Demographics
NPI:1790831956
Name:LUSENHOP, MARIAN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:
Last Name:LUSENHOP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 N BEND RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7610
Mailing Address - Country:US
Mailing Address - Phone:513-662-9900
Mailing Address - Fax:513-662-9902
Practice Address - Street 1:3253 N BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7610
Practice Address - Country:US
Practice Address - Phone:513-662-9900
Practice Address - Fax:513-662-9902
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00042051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical