Provider Demographics
NPI:1790421329
Name:JACOB STUDIOSO, LCSW, PLLC
Entity Type:Organization
Organization Name:JACOB STUDIOSO, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:STUDIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-628-4200
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-0706
Mailing Address - Country:US
Mailing Address - Phone:585-628-4200
Mailing Address - Fax:585-628-4280
Practice Address - Street 1:84 AVON GENESEO RD
Practice Address - Street 2:SUITE B
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-628-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)