Provider Demographics
NPI:1730305202
Name:JACOBSON, BRIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W 9TH ST
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8971
Mailing Address - Country:US
Mailing Address - Phone:212-254-1618
Mailing Address - Fax:212-254-2427
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:SUITE 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:212-254-1618
Practice Address - Fax:212-254-2427
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical