Adeena Jacobson, MSED, BCBA
Individual provider Active NPI Behavior Analyst · Monsey, NY
NPI 1437411550 · NPPES record last updated Jun 14, 2012
Key facts
- NPI
- 1437411550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 1-10-7307 (NY)
- Practice address
- 5 Jodi CT
Monsey, NY 10952-1115 - Phone
- (917) 882-2744
- Fax
- (845) 354-7991
- NPI assigned
- Jun 14, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1148437 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portum Wellness and Recovery | Current | Accepting new patients | |
| Project Blue Therapy LLC | Behavior Analyst | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-10-7307 | NY | Yes |
| Specialist | 174400000X | 1148437 | NY |
Addresses
Primary practice location
5 Jodi CT
Monsey, NY 10952-1115
Mailing address
5 Jodi CT
Monsey, NY 10952-1115
Phone (917) 882-2744
Other providers in Monsey, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.