| Doctor Name: | MR. KENNETH G JACOBS |
| NPI Number: | 1730462524 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 073370-1 |
| Business Practice Address: | 6292 Gardner Rd Altamont, NY - 120095016 |
| Business Phone Number: | 5188615138 |
| Business Fax Number: | |
| Mailing Address: | 6292 Gardner Road, ALTAMONT |
| State: | NY |
| Postal Code: | 120090371 |
| Phone Number: | 5188615138 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2011 |
| NPI Last Update Date: | 09/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | 073370-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |