Jacqueline Lobosco, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

019373 Issued in NY

Practice address

200 Belle Terre Rd
Port Jefferson, NY 11777-1928

Phone

(631) 474-6300

NPI assigned

Apr 14, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397433600000",
    "number": "1225457765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOBOSCO",
        "first_name": "JACQUELINE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-14",
        "last_updated": "2014-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "019373",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "019373",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Livian, LMSW
• Igor Lizogubenko, P.A.
• Anthony L Llorens, MD
• Hannah Claire Lo
• Careena Ann Lobo
• Dominick Lociero, LMHC (LICENSE MENTAL
• Jacqueline T Loehr, RN
• Keri A Logan, DMD
• Paul Louis Lograno
• Jessica Lombardi, PA

• Clinical Neuropsychologist in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.