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General NPI Number Information
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NPI Number | 1912046640
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Entity Type | Individual
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Provider Name | LUKOSE JACOB LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 200 SW 62ND BLVD
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City | GAINESVILLE
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State | FL
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Zip | 32607-2083
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Country | US
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Telephone | 352-376-8211
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Fax | 352-373-7594
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Provider Business Mailing Address
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Address Line | 7108 SW 80TH TER DEPT OF
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City | GAINESVILLE
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State | FL
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Zip | 32608-8412
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Country | US
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Telephone | 352-327-0293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11962
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License Number State | FL
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