Provider Demographics
NPI:1437411550
Name:JACOBSON, ADEENA (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:ADEENA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JODI CT
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1115
Mailing Address - Country:US
Mailing Address - Phone:917-882-2744
Mailing Address - Fax:845-354-7991
Practice Address - Street 1:5 JODI CT
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1115
Practice Address - Country:US
Practice Address - Phone:917-882-2744
Practice Address - Fax:845-354-7991
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-10-7307103K00000X
NY1148437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist