Provider Demographics
NPI:1205086766
Name:LUGO ESTRADA, JOSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:LUGO ESTRADA
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HIGH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3723
Mailing Address - Country:US
Mailing Address - Phone:508-499-9231
Mailing Address - Fax:
Practice Address - Street 1:850 HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3723
Practice Address - Country:US
Practice Address - Phone:508-499-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103T00000X, 103TH0100X
MA10995103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service