Provider Demographics
NPI:1912046640
Name:JACOB, LUKOSE (LCSW)
Entity type:Individual
Prefix:MR
First Name:LUKOSE
Middle Name:
Last Name:JACOB
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 1:7108 SW 80TH TER DEPT OF
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8412
Mailing Address - Country:US
Mailing Address - Phone:352-327-0293
Mailing Address - Fax:
Practice Address - Street 1:200 SW 62ND BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2083
Practice Address - Country:US
Practice Address - Phone:352-376-8211
Practice Address - Fax:352-373-7594
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW119621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical