Provider Demographics
NPI:1174654107
Name:JACOBSON, ADAM (LCSW, MSOD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:LCSW, MSOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 W 81ST ST
Mailing Address - Street 2:SUITE # 51
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5954
Mailing Address - Country:US
Mailing Address - Phone:212-875-1867
Mailing Address - Fax:212-875-1867
Practice Address - Street 1:158 W 81ST ST
Practice Address - Street 2:SUITE # 51
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5954
Practice Address - Country:US
Practice Address - Phone:212-875-1867
Practice Address - Fax:212-875-1867
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical