Provider Demographics
NPI:1902388515
Name:JACOB, ANJALI (LMHC)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:JACOB
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 1:629 STERLING PL APT 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4820
Mailing Address - Country:US
Mailing Address - Phone:425-445-8868
Mailing Address - Fax:
Practice Address - Street 1:629 STERLING PL APT 3R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4820
Practice Address - Country:US
Practice Address - Phone:425-445-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY011067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health