Provider Demographics
NPI:1306071717
Name:JACOBS, LAUREN NICOLE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COLVIN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1242
Mailing Address - Country:US
Mailing Address - Phone:518-438-2222
Mailing Address - Fax:518-438-7777
Practice Address - Street 1:1600 7TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3410
Practice Address - Country:US
Practice Address - Phone:518-270-2800
Practice Address - Fax:518-270-2723
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081208-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical