Provider Demographics
NPI:1013224492
Name:JACOBS, MAUREEN ANNE
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANNE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:ANNE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94 W EARLE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2513
Mailing Address - Country:US
Mailing Address - Phone:410-822-8561
Mailing Address - Fax:
Practice Address - Street 1:120 BANJO LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1002
Practice Address - Country:US
Practice Address - Phone:410-758-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical