Individual
DR. SUSAN JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 E SHORE RD, SUITE 301, GREAT NECK, NY 11023-2410
(516) 661-6666
Mailing address
20548 BRIAN CRES, BAYSIDE, NY 11360-1142
(516) 661-6666
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
010031
NY
Other
Enumeration date
06/11/2009
Last updated
06/11/2009
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