Provider Demographics
NPI:1922137256
Name:JACOBS, CARL (LP DSC)
Entity Type:Individual
Prefix:PROF
First Name:CARL
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LP DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W 9TH ST
Mailing Address - Street 2:1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8936
Mailing Address - Country:US
Mailing Address - Phone:212-243-5816
Mailing Address - Fax:
Practice Address - Street 1:17 W 9TH ST
Practice Address - Street 2:1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8936
Practice Address - Country:US
Practice Address - Phone:212-243-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000028-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst