Provider Demographics
NPI:1003839036
Name:JACOBSON, MARILYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TOTTENHAM LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8549
Mailing Address - Country:US
Mailing Address - Phone:919-929-9885
Mailing Address - Fax:919-942-2003
Practice Address - Street 1:2 TOTTENHAM LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8549
Practice Address - Country:US
Practice Address - Phone:919-929-9885
Practice Address - Fax:919-942-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical