Provider Demographics
NPI:1962826198
Name:LORASO, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LORASO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28552 SHADY DAY DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-2851
Mailing Address - Country:US
Mailing Address - Phone:318-381-3124
Mailing Address - Fax:
Practice Address - Street 1:28552 SHADY DAY DR
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-2851
Practice Address - Country:US
Practice Address - Phone:318-381-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2022-08-10
Deactivation Date:2015-12-18
Deactivation Code:
Reactivation Date:2022-08-10
Provider Licenses
StateLicense IDTaxonomies
LA5474101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor