Individual
JEAN M. JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1020 MARY ST, UTICA, NY 13501-1930
(315) 724-6907
(315) 733-0791
Mailing address
1601 ARMORY DR, UTICA, NY 13501-5405
(315) 797-6241
(315) 738-7777
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
016479
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01039156
—
NY
Enumeration date
08/27/2007
Last updated
09/18/2008
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