| Doctor Name: | MISS MELISSA H JACOBSON |
| NPI Number: | 1174875421 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NPP |
| License Number: | 401530 |
| Business Practice Address: | 800 Cross River Rd Katonah, NY - 105363549 |
| Business Phone Number: | 9147638151 |
| Business Fax Number: | |
| Mailing Address: | 97 Mobile Ave, STATEN ISLAND |
| State: | NY |
| Postal Code: | 103062127 |
| Phone Number: | 7186796561 |
| Fax Number: | |
| NPI Enumeration Date: | 10/11/2012 |
| NPI Last Update Date: | 10/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 401530 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |