Provider Demographics
NPI:1922033893
Name:JACOBSON, LAWRENCE DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 20TH ST
Mailing Address - Street 2:SUITE 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1310
Mailing Address - Country:US
Mailing Address - Phone:212-533-5316
Mailing Address - Fax:212-533-5316
Practice Address - Street 1:30 E 20TH ST
Practice Address - Street 2:SUITE 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1310
Practice Address - Country:US
Practice Address - Phone:212-533-5316
Practice Address - Fax:212-533-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPSY8947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV68341Medicare ID - Type Unspecified