Individual
ALYSSA JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75 GRAND AVE, MASSAPEQUA, NY 11758-4905
(516) 799-3203
Mailing address
56 BROADWAY, MASSAPEQUA PARK, NY 11762-2813
(347) 229-3551
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/14/2024
Last updated
03/14/2024
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