Provider Demographics
NPI:1295950178
Name:JAKUBOWICZ, SUSAN J (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:JAKUBOWICZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 21ST ST
Mailing Address - Street 2:1-K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6543
Mailing Address - Country:US
Mailing Address - Phone:212-473-1400
Mailing Address - Fax:212-260-7564
Practice Address - Street 1:301 E 21ST ST
Practice Address - Street 2:1-K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6543
Practice Address - Country:US
Practice Address - Phone:212-473-1400
Practice Address - Fax:212-260-7564
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR30155-21041C0700X
NY000381-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst