Provider Demographics
NPI:1528566858
Name:LUGO, JONATHAN (BCBA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LUGO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 CHANCELLOR ST NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3305
Mailing Address - Country:US
Mailing Address - Phone:202-308-6888
Mailing Address - Fax:
Practice Address - Street 1:40347 US HIGHWAY 19 N STE 103
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4841
Practice Address - Country:US
Practice Address - Phone:202-308-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA782103K00000X
FL1-19-39022103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst