Kimberly Brett Jakobson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

095300 Issued in NY

Practice address

1627 Trumansburg Rd
Ithaca, NY 14850-9213

Phone

(504) 296-1859

NPI assigned

May 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1558396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1912564469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1627 TRUMANSBURG RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148509213",
            "telephone_number": "504-296-1859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 TRUMANSBURG RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148509213",
            "telephone_number": "504-296-1859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKOBSON",
        "first_name": "KIMBERLY",
        "middle_name": "BRETT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-21",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "106130",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "095300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Franklin Jackson, P.T., DPT, MPS, OCS
• Jaclyn Borza Maher, D.C., PLLC
• Amy Lee Jacobs, LISW
• Paula L. Jacobs, LCSW
• Patti L Jacobson, DC
• Maureen Bernier Jakubson, OTR
• Lucia Jander, MD
• Barbara Jastran, LCSW-R
• Lilly Jay
• Gayatri Jayaraman, MD

• Clinical Social Worker in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.