License Detail

NameJACOBSON DIANE R
AddressNEW YORKNY
ProfessionLICENSED CLINICAL SOCIAL WORK
License No021050
Date of Licensure09/01/04  (OriginallylicensedasaCertifiedSocialWorkeron01/26/79)
Additional QualificationP -3-year psychotherapy privilege
StatusINACTIVE
Registered through last day of

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