Provider Demographics
NPI:1114460862
Name:JACOBS, ISAAC JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:JOHN
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1326
Mailing Address - Country:US
Mailing Address - Phone:585-708-1537
Mailing Address - Fax:585-623-8182
Practice Address - Street 1:36 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1326
Practice Address - Country:US
Practice Address - Phone:585-708-1537
Practice Address - Fax:585-623-8182
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0906181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical