Individual
MS. BERTHA ELIZABETH JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW R
Contact information
Practice address
226 RANDOLPH STREET, SYRACUSE, NY 13205
(315) 492-6094
Mailing address
226 RANDOLPH STREET, SYRACUSE, NY 13205
(315) 492-6094
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
036843
NY
Other
Enumeration date
09/24/2007
Last updated
09/24/2007
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