Provider Demographics
NPI:1124491261
Name:JUSINO, VERONICA MIA (LPC, CAADC)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:MIA
Last Name:JUSINO
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:MIA
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:22 NORTHEAST DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2732
Practice Address - Country:US
Practice Address - Phone:717-531-8338
Practice Address - Fax:717-531-6250
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional