Individual
JORDAN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
483 CLERMONT AVE FL 3, BROOKLYN, NY 11238-2253
(718) 643-5300
Mailing address
160 PARKSIDE AVE APT 6H, BROOKLYN, NY 11226-1265
(760) 815-2581
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
P106579
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P106579
—
NY
Enumeration date
10/01/2020
Last updated
10/01/2020
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