=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417625559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARI JACOBS, LCSW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2021
-----------------------------------------------------
Last Update Date | 09/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 276 5TH AVE # 704-1938
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-279-3950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1550 LARIMER ST STE 186
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80202-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-279-3950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHARI JACOBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 929-279-3950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------