Individual
LESLIE JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 CHURCH ST S, SUITE 207, NEW HAVEN, CT 06519-1717
(203) 764-8480
(203) 764-8484
Mailing address
45 RESERVOIR ST, NEW HAVEN, CT 06511-1227
(203) 624-6932
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
030919
CT
Other
Enumeration date
07/14/2006
Last updated
07/08/2007
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