Active NPI
Edith Claire Jacobs, PHD
- Clinical Psychologist
- Buffalo, NY
National Provider Identifier
1346469293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 009157
- Practice address
- 406 Linwood Ave
Buffalo, NY 14209 - Phone
- (716) 886-7304
- Fax
- (716) 886-7398
- NPI assigned
- Apr 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 009157 | NY | Primary |
Addresses
Primary practice location
406 Linwood Ave
Buffalo, NY 14209
Mailing address
406 Linwood Ave
Buffalo, NY 14209
Phone (716) 886-7304
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02103753 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346469293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 LINWOOD AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "14209",
"telephone_number": "716-886-7304",
"fax_number": "716-886-7398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 LINWOOD AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "14209",
"telephone_number": "716-886-7304",
"fax_number": "716-886-7398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "EDITH",
"middle_name": "CLAIRE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "009157",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02103753",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.