Provider Demographics
NPI:1811220031
Name:JACOBY, JUDITH (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:JACOBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7701 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2413
Mailing Address - Country:US
Mailing Address - Phone:718-232-1351
Mailing Address - Fax:
Practice Address - Street 1:7701 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2413
Practice Address - Country:US
Practice Address - Phone:718-232-1351
Practice Address - Fax:718-837-5676
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031989104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker