Provider Demographics
NPI:1407277064
Name:ALISON JACOB, MSW, LCSW, LLC
Entity Type:Organization
Organization Name:ALISON JACOB, MSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LLC
Authorized Official - Phone:518-878-3227
Mailing Address - Street 1:1541 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6001
Mailing Address - Country:US
Mailing Address - Phone:518-878-3227
Mailing Address - Fax:
Practice Address - Street 1:1541 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6001
Practice Address - Country:US
Practice Address - Phone:518-878-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health