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Individual

JACOB ETHAN SMALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
286 MADISON AVENUE, SUITE 1602, NEW YORK, NY 10017
(917) 704-3761
Mailing address
286 MADISON AVENUE, SUITE 1602, NEW YORK, NY 10017
(917) 704-3761

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0156821
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02567971
NY
Enumeration date
07/18/2006
Last updated
04/29/2008
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