Healthcare Provider Details

I. General information

NPI: 1023527611
Provider Name (Legal Business Name): LINDA JACOBS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 5TH AVENUE SUTIE 1D
NEW YORK NY
10011
US

IV. Provider business mailing address

96 5TH AVENUE SUITE 1D
NEW YORK NY
10011
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-1871
  • Fax: 212-533-3826
Mailing address:
  • Phone: 212-677-1871
  • Fax: 212-533-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009332-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: