Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | MA | |
N | 103T00000X | Psychologist | MA | |
Y | 103G00000X | Clinical Psychologist | 10995 | MA |
Y | 103TC0700X | Clinical Psychologist | 10995 | MA |
N | 103TH0100X | Health Service | MA |
NPI | 1205086766 |
---|---|
Provider Name | Dr. Jose Lugo |
First Address | East Bridgewater, MA 02333-1908 |
Second Address | East Bridgewater, MA 02333-1908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2008 |
Last Update Date | 10/12/2020 |