Individual
EDWARD JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24X STONEY GROUND, FREDERIKSTED, VI 00841
(917) 569-8303
Mailing address
PO BOX 392, FREDERIKSTED, VI 00841-0392
(917) 569-8303
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1207
CT
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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