Individual
DR. EDITH CLAIRE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
406 LINWOOD AVE, BUFFALO, NY 14209
(716) 886-7304
(716) 886-7398
Mailing address
406 LINWOOD AVE, BUFFALO, NY 14209
(716) 886-7304
(716) 886-7398
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
009157
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02103753
—
NY
Enumeration date
04/25/2007
Last updated
07/08/2007
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