Provider Demographics
NPI:1104514140
Name:VARANASI-LEE, JINA
Entity type:Individual
Prefix:
First Name:JINA
Middle Name:
Last Name:VARANASI-LEE
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 1:5617 INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3704
Mailing Address - Country:US
Mailing Address - Phone:161-444-0803
Mailing Address - Fax:
Practice Address - Street 1:5617 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3704
Practice Address - Country:US
Practice Address - Phone:161-444-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.12012651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical