Provider Demographics
NPI:1154844280
Name:LUSETTI, JENNIFER R (LISW-SUPV)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:LUSETTI
Suffix:
Gender:F
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 W CHURCH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5050
Mailing Address - Country:US
Mailing Address - Phone:740-934-6474
Mailing Address - Fax:740-934-6473
Practice Address - Street 1:68 W CHURCH ST STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5050
Practice Address - Country:US
Practice Address - Phone:740-934-6474
Practice Address - Fax:740-934-6473
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293779Medicaid
OHI.2102780-SUPVOtherOHIO COUNSELOR, SOCIAL WORKER & MFT BOARD