Provider Demographics
NPI:1932255437
Name:SCHWAB, JACOB (MED PSYD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:MED PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LYNCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1628
Mailing Address - Country:US
Mailing Address - Phone:845-354-4223
Mailing Address - Fax:845-354-3018
Practice Address - Street 1:55 OLD NYACK TURNPIKE
Practice Address - Street 2:SUITE 601
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:845-624-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist