Provider Demographics
NPI:1306017272
Name:JACOBSEN, ERIN VIOLA (MA, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:VIOLA
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E HARTSDALE AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3315
Mailing Address - Country:US
Mailing Address - Phone:610-368-1354
Mailing Address - Fax:
Practice Address - Street 1:212 MONTGOMERY AVE
Practice Address - Street 2:SUITE
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-338-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322D00000X
NY001296-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children