Healthcare Provider Details

I. General information

NPI: 1649397068
Provider Name (Legal Business Name): ALLAN MICHAEL JACOBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 S MAIN ST SUITE 305
WEST HARTFORD CT
06107-2486
US

IV. Provider business mailing address

61 S MAIN ST SUITE 305
WEST HARTFORD CT
06107-2486
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-1640
  • Fax:
Mailing address:
  • Phone: 860-561-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number027910
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number027910
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number027910
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: