Provider Demographics
NPI:1962861732
Name:LUSTICA, HENNESSEY (LMHC)
Entity Type:Individual
Prefix:
First Name:HENNESSEY
Middle Name:
Last Name:LUSTICA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAREDON PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4070
Mailing Address - Country:US
Mailing Address - Phone:585-500-5488
Mailing Address - Fax:
Practice Address - Street 1:3 SAREDON PL
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4070
Practice Address - Country:US
Practice Address - Phone:585-500-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18007089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health