Provider Demographics
NPI:1245480961
Name:LUSKO, JEFFERY JOSEPH (MA, LLP)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:JOSEPH
Last Name:LUSKO
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30220 SOUTHFIELD RD APT 144
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1315
Mailing Address - Country:US
Mailing Address - Phone:313-506-2272
Mailing Address - Fax:248-258-0458
Practice Address - Street 1:27655 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:313-506-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361005144103TC0700X
MI6301008576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty