Provider Demographics
NPI:1831143445
Name:JACOBSON, SUSAN HALPERN (RN LMHC CASAC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HALPERN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RN LMHC CASAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:66 FINCH DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576
Mailing Address - Country:US
Mailing Address - Phone:516-626-3016
Mailing Address - Fax:516-621-5234
Practice Address - Street 1:333 E SHORE RD
Practice Address - Street 2:STE 206
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-626-3016
Practice Address - Fax:516-621-5234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13220101YA0400X
NY0003191101YM0800X
NY3569171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse