| Doctor Name: | MR. LUKOSE JACOB |
| NPI Number: | 1912046640 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | XXXXXX |
| Business Practice Address: | 7765 S County Road 231 Lake Butler, FL - 320545721 |
| Business Phone Number: | 3864966000 |
| Business Fax Number: | |
| Mailing Address: | 7765 S Cr 251, Rmc-dept. Of Corrections, LAKE BUTLER |
| State: | FL |
| Postal Code: | 32504 |
| Phone Number: | 3864966000 |
| Fax Number: | |
| NPI Enumeration Date: | 02/06/2007 |
| NPI Last Update Date: | 11/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | XXXXXX |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |