| Doctor Name: | MR. GARY MICHAEL JACOBSON |
| NPI Number: | 1073692695 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, CASAC |
| License Number: | ME266469 |
| Business Practice Address: | 7 Prospect St New Paltz, NY - 125611137 |
| Business Phone Number: | 8452562220 |
| Business Fax Number: | 8452559211 |
| Mailing Address: | 6 Walnut Ln, ROSENDALE |
| State: | NY |
| Postal Code: | 124729734 |
| Phone Number: | 8456583606 |
| Fax Number: | 8456583606 |
| NPI Enumeration Date: | 11/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | ME266469 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |