MEDICARE: DANIELLA JACOBS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	099056-01	NY

General Provider Information

NPI Number	:	1194487918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA JACOBS LCSW

Provider Business Mailing Address
First Line	:	15 LAUREL CT
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-4109
Country	:	US
Telephone Number	:	201-546-4376
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	201-546-4376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	01/14/2026

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