Provider Demographics
NPI:1043023336
Name:HENNESSY, CHRISTINA LYNN
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LYNN
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 W DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1436
Mailing Address - Country:US
Mailing Address - Phone:614-467-9554
Mailing Address - Fax:
Practice Address - Street 1:333 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4963
Practice Address - Country:US
Practice Address - Phone:614-467-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-25-408835106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician