Provider Demographics
NPI:1851766612
Name:FUSCO, JEREMY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:FUSCO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 GREENVILLE AVE STE 100-101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4130
Mailing Address - Country:US
Mailing Address - Phone:469-496-5695
Mailing Address - Fax:469-242-9730
Practice Address - Street 1:4849 GREENVILLE AVE STE 100-101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4130
Practice Address - Country:US
Practice Address - Phone:469-496-5695
Practice Address - Fax:469-242-9730
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical