Provider Demographics
NPI:1073649026
Name:JACOBS, PAMELA RAVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:RAVIN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3707
Mailing Address - Country:US
Mailing Address - Phone:917-282-5569
Mailing Address - Fax:
Practice Address - Street 1:ALBERT EINSTEIN COLLEGE OF MEDICINE-CERC
Practice Address - Street 2:1165 MORRIS PARK AVE.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-430-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016825-1103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool