Provider Demographics
NPI:1710249040
Name:LOZANO, JACKELINE (MSSE)
Entity Type:Individual
Prefix:MRS
First Name:JACKELINE
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:MSSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 55TH AVE
Mailing Address - Street 2:APT 6C
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4553
Mailing Address - Country:US
Mailing Address - Phone:917-544-9716
Mailing Address - Fax:
Practice Address - Street 1:9777 QUEENS BLVD
Practice Address - Street 2:PENT HOUSE
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3335
Practice Address - Country:US
Practice Address - Phone:718-830-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency