Healthcare Provider Details

I. General information

NPI: 1437070976
Provider Name (Legal Business Name): JESSICA MARIE LORUSSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 STATE ST
SPRINGFIELD MA
01109-4104
US

IV. Provider business mailing address

576 STATE ST
SPRINGFIELD MA
01109-4104
US

V. Phone/Fax

Practice location:
  • Phone: 413-781-6485
  • Fax: 413-788-6925
Mailing address:
  • Phone: 413-781-6485
  • Fax: 413-788-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: