Provider Demographics
NPI:1700093424
Name:DESCHENES, DENISE LUCILLE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LUCILLE
Last Name:DESCHENES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:DESCHENES
Other - Last Name:LUSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 NEIL AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2333
Mailing Address - Country:US
Mailing Address - Phone:614-292-5766
Mailing Address - Fax:614-688-3440
Practice Address - Street 1:1640 NEIL AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2333
Practice Address - Country:US
Practice Address - Phone:614-292-5766
Practice Address - Fax:614-688-3440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350616112084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0943966Medicaid
OH0943966Medicaid