Provider Demographics
NPI:1205099470
Name:NESLUSAN, SERENA MICHELLE (MA)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:MICHELLE
Last Name:NESLUSAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:SERENA
Other - Middle Name:MICHELLE
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:508-831-0045
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:585 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1906
Practice Address - Country:US
Practice Address - Phone:508-831-0045
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18684OtherBCBS
MA1308785Medicaid
MA1306421Medicaid
MA1308785Medicaid