Individual
BONNIE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
15 EVERGREEN DR, MANORVILLE, NY 11949-3215
(631) 444-2938
Mailing address
PO BOX 826, EAST SETAUKET, NY 11733-0636
(631) 444-2938
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
010569
NY
Other
Enumeration date
03/08/2007
Last updated
07/08/2007
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