Individual
MR. KENNETH G JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6292 GARDNER RD, ALTAMONT, NY 12009-5016
(518) 861-5138
Mailing address
6292 GARDNER ROAD, ALTAMONT, NY 12009-0371
(518) 861-5138
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
073370-1
NY
Other
Enumeration date
09/28/2011
Last updated
09/28/2011
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