Provider Demographics
NPI:1053827394
Name:AYBAR-JACOBS, KARINA (LMSW, CPC)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:AYBAR-JACOBS
Suffix:
Gender:F
Credentials:LMSW, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 W 136TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2639
Mailing Address - Country:US
Mailing Address - Phone:347-281-9091
Mailing Address - Fax:
Practice Address - Street 1:270 W 136TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2639
Practice Address - Country:US
Practice Address - Phone:347-281-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1027231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000351-1Medicaid