Individual
JACQUELINE LOBOSCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
200 BELLE TERRE RD, PORT JEFFERSON, NY 11777-1928
(631) 474-6300
Mailing address
200 BELLE TERRE RD, PORT JEFFERSON, NY 11777-1928
(631) 474-6300
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
019373
NY
103T00000X
Psychologist
019373
NY
Other
Enumeration date
04/14/2014
Last updated
04/14/2014
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