| Gabrielle Lofaso | |
|
1000 Main Sreet Port Jefferson NY 11777 | |
| (631) 331-9083 | |
| Not Available |
| Full Name | Gabrielle Lofaso |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1000 Main Sreet, Port Jefferson, New York |
| Authorized Official Name and Position | Gabrielle Lofaso (PSYCHOLOGIST) |
| Authorized Official Contact | 6313319083 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gabrielle Lofaso 655 Belle Terre Rd Apt #30 Port Jefferson NY 11777-1960 Ph: (631) 331-9083 | Gabrielle Lofaso 1000 Main Sreet Port Jefferson NY 11777 Ph: (631) 331-9083 |
| NPI Number | 1144629585 |
|---|---|
| Provider Enumeration Date | 08/21/2014 |
| Last Update Date | 08/21/2014 |
| Medicare PECOS PAC ID | 4981927829 |
|---|---|
| Medicare Enrollment ID | O20141229000236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144629585 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 013610 (New York) | Primary |
| Provider Name | Gabrielle Lofaso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316152671 PECOS PAC ID: 3274518204 Enrollment ID: I20040623000056 |
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