Provider Demographics
NPI:1194615369
Name:JACOBS, KEEAUNA (MHC-LP)
Entity type:Individual
Prefix:
First Name:KEEAUNA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BRONXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3612
Mailing Address - Country:US
Mailing Address - Phone:718-518-9007
Mailing Address - Fax:718-518-9007
Practice Address - Street 1:2800 BRONXWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3612
Practice Address - Country:US
Practice Address - Phone:718-518-9007
Practice Address - Fax:718-518-9007
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health