Provider Demographics
NPI:1114049145
Name:JACOBS, LEAH PITTELL
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:PITTELL
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:PITTELL
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:30 W 15TH ST
Mailing Address - Street 2:6 N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6816
Mailing Address - Country:US
Mailing Address - Phone:212-489-2397
Mailing Address - Fax:
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:10 L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4312
Practice Address - Country:US
Practice Address - Phone:212-489-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0214971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical