Provider Demographics
NPI:1326009416
Name:JACOBSONPEREZ, SELENA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:
Last Name:JACOBSONPEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 67TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3051
Mailing Address - Country:US
Mailing Address - Phone:718-520-0834
Mailing Address - Fax:
Practice Address - Street 1:9916 67TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3051
Practice Address - Country:US
Practice Address - Phone:718-520-0834
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0714001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical