Provider Demographics
NPI:1447561493
Name:LOSECCO, JUDITH (LMSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:LOSECCO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 MICKLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6203
Mailing Address - Country:US
Mailing Address - Phone:718-881-3852
Mailing Address - Fax:
Practice Address - Street 1:2417 MICKLE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6203
Practice Address - Country:US
Practice Address - Phone:718-881-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049657-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool