Provider Demographics
NPI:1811589948
Name:JACOBS, LEAH (LMHC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KINGSGATE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4537
Mailing Address - Country:US
Mailing Address - Phone:716-217-5178
Mailing Address - Fax:
Practice Address - Street 1:20 KINGSGATE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-4537
Practice Address - Country:US
Practice Address - Phone:716-217-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health