Provider Demographics
NPI:1811504665
Name:CATHERINE MARIE JACOBSEN, LMHC, PLLC
Entity type:Organization
Organization Name:CATHERINE MARIE JACOBSEN, LMHC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:845-248-3722
Mailing Address - Street 1:110 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5464
Mailing Address - Country:US
Mailing Address - Phone:845-248-3722
Mailing Address - Fax:
Practice Address - Street 1:1 SPRING SQUARE BUSINESS PARK UNIT 2
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2566
Practice Address - Country:US
Practice Address - Phone:845-248-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009263-01OtherLICENSE