MEDICARE: JOSEPHINE LOIACONO-DONOVAN PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	013537	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013537	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1083770929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE LOIACONO-DONOVAN PSYD

Provider Business Mailing Address
First Line	:	2228-63RD ST.
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204
Country	:	US
Telephone Number	:	917-975-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329-49TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219
Country	:	US
Telephone Number	:	917-975-9186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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