Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 086264-1 | NY |
NPI | 1003263294 |
---|---|
Provider Name | Ms. Jennifer M.b. Jacobs |
First Address | New York, NY 10023 |
Second Address | New York, NY 10024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 20/02/2020 |