Healthcare Provider Details

I. General information

NPI: 1871423426
Provider Name (Legal Business Name): JENNA DEFUSCO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EAST ST
CRANSTON RI
02920-4421
US

IV. Provider business mailing address

180 WATERMAN AVE APT 210
NORTH PROVIDENCE RI
02911-4103
US

V. Phone/Fax

Practice location:
  • Phone: 401-592-1425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC02024
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: