Healthcare Provider Details

I. General information

NPI: 1205086766
Provider Name (Legal Business Name): JOSE LUGO ESTRADA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BEECH ST
HOLYOKE MA
01040-3968
US

IV. Provider business mailing address

850 HIGH ST STE 3
HOLYOKE MA
01040-3723
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax:
Mailing address:
  • Phone: 508-499-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10995
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: