MEDICARE: MRS. AMELIA ROSE LUGO PSY

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	PSY30224	CA

General Provider Information

NPI Number	:	1700364486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMELIA ROSE LUGO PSY

Provider Business Mailing Address
First Line	:	2512 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3506
Country	:	US
Telephone Number	:	818-322-0075
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3506
Country	:	US
Telephone Number	:	818-322-0075
Fax Number	:

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

Provider Enumeration Date	:	08/03/2018
Last Update Date	:	05/14/2025

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