Provider Demographics
NPI:1518614072
Name:JACOBSON, COLLEEN MCCLAIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MCCLAIN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SPANISH COVE RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3815
Mailing Address - Country:US
Mailing Address - Phone:646-207-3563
Mailing Address - Fax:
Practice Address - Street 1:2 SPANISH COVE RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3815
Practice Address - Country:US
Practice Address - Phone:646-207-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical