Doctor Name: | JERROLD JACOBSON |
NPI Number: | 1033413315 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BCBA CAP LMHC |
License Number: | 2389 |
Business Practice Address: | 7422 Sw Horse Creek Rd Arcadia, FL - 342668894 |
Business Phone Number: | 8634949251 |
Business Fax Number: | 8634949251 |
Mailing Address: | 7422 Sw Horse Creek Rd, ARCADIA |
State: | FL |
Postal Code: | 342668894 |
Phone Number: | 8634949251 |
Fax Number: | 8634949251 |
NPI Enumeration Date: | 12/31/2010 |
NPI Last Update Date: | 12/31/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 2389 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |