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General NPI Number Information
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NPI Number | 1679193973
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Entity Type | Individual
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Provider Name | REYNA LUSSON
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 750 E LONG ST
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City | COLUMBUS
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State | OH
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Zip | 43203-1846
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Country | US
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Telephone | 614-340-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 107 E MAYNARD AVE
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City | COLUMBUS
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State | OH
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Zip | 43202-2940
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Country | US
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Telephone | 614-915-7290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2001321-TRNE
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License Number State | OH
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