Provider Demographics
NPI:1922198241
Name:JACOBSON LEVY, MINDY (MCAT, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:JACOBSON LEVY
Suffix:
Gender:F
Credentials:MCAT, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3238
Mailing Address - Country:US
Mailing Address - Phone:215-570-4304
Mailing Address - Fax:
Practice Address - Street 1:601 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3238
Practice Address - Country:US
Practice Address - Phone:215-570-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001934101YP2500X
NJ37PC0181900101YP2500X
221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1213901OtherAETNA