Susan Jacobson

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

010031 Issued in NY

Practice address

310 E Shore Rd
Suite 301
Great Neck, NY 11023-2410

Phone

(516) 661-6666

NPI assigned

Jun 11, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244678400000",
    "number": "1730316167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20548 BRIAN CRES",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113601142",
            "telephone_number": "516-661-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E SHORE RD",
            "address_2": "SUITE 301",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110232410",
            "telephone_number": "516-661-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-11",
        "last_updated": "2009-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "010031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jed Jabiguero
• Jack Fried, OD, PC
• Jacob Gohari, MD PLLC
• Mitchel Jacobs, MD
• Daniel R Jacobsen, MS, FNP-BC
• Matthew David Jacofsky, PSY.D.
• Andrew Angelo Jacono, MD
• Roya Jafari-Hassad, MD
• Shuchie Jaggi, D.O.
• Tahmina Jahir, MD

• Clinical Child & Adolescent Psychologist in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Clinical Child & Adolescent Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.