Healthcare Provider Details

I. General information

NPI: 1215111661
Provider Name (Legal Business Name): SUSANNAH JACOBI, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W 86TH ST STE 1A
NEW YORK NY
10024-4028
US

IV. Provider business mailing address

144 W 86TH ST STE 1A
NEW YORK NY
10024-4028
US

V. Phone/Fax

Practice location:
  • Phone: 646-290-8404
  • Fax: 888-290-2182
Mailing address:
  • Phone: 646-290-8404
  • Fax: 888-290-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015752
License Number StateNY

VIII. Authorized Official

Name: SUSANNAH GILLE JACOBI
Title or Position: PRESIDENT
Credential: PHD
Phone: 646-290-8404