Provider Demographics
NPI:1457860025
Name:STUDIOSO, JACOB (LCSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:STUDIOSO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 STE B
Practice Address - Street 2:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1011521041C0700X
NY0906191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical