Doctor Name: | MS. CHARLENE R JACOBS |
NPI Number: | 1467448910 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3997 |
Business Practice Address: | 21 Regal St Holliston, MA - 017461808 |
Business Phone Number: | 5084295242 |
Business Fax Number: | |
Mailing Address: | 21 Regal St, HOLLISTON |
State: | MA |
Postal Code: | 017461808 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/21/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3997 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |