Basic Information
Provider Information | |||||||||
NPI: | 1710262647 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JACOBSON | ||||||||
FirstName: | ESTHER | ||||||||
MiddleName: | SHARON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | EDELSTEIN | ||||||||
OtherFirstName: | ESTHER | ||||||||
OtherMiddleName: | SHARON | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LCSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2535 ARTHUR KILL RD | ||||||||
Address2: |   | ||||||||
City: | STATEN ISLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 103091207 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7184483210 | ||||||||
FaxNumber: | 7189676023 | ||||||||
Practice Location | |||||||||
Address1: | 65 COLUMBUS AVE | ||||||||
Address2: |   | ||||||||
City: | STATEN ISLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 103044325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7184483210 | ||||||||
FaxNumber: | 7189676023 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/11/2011 | ||||||||
LastUpdateDate: | 10/11/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 078761 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.