Individual
CARRIE LEE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-9651
Mailing address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 432-0941
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
072356
NY
1041C0700X
Clinical Social Worker
Primary
099096
NY
Other
Enumeration date
04/14/2021
Last updated
12/16/2024
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