Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 016825-1 | NY |
NPI | 1073649026 |
---|---|
Provider Name | Dr. Pamela Ravin Jacobs |
First Address | Brooklyn, NY 11215-3707 |
Second Address | Bronx, NY 10461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |