Provider Demographics
NPI:1093868101
Name:JACOBS, LESLIE P (MSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:P
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 COTTAGE TER
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2210
Mailing Address - Country:US
Mailing Address - Phone:914-244-9144
Mailing Address - Fax:914-244-9143
Practice Address - Street 1:547 SAW MILL RIVER RD STE LL1
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2155
Practice Address - Country:US
Practice Address - Phone:917-498-2173
Practice Address - Fax:914-244-9143
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071082-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical