Provider Demographics
NPI:1104528942
Name:PATKIN, JACOB MATTHEW
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:MATTHEW
Last Name:PATKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 OSSIPEE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1609
Mailing Address - Country:US
Mailing Address - Phone:617-855-9295
Mailing Address - Fax:
Practice Address - Street 1:521 MOUNT AUBURN ST STE 205
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4153
Practice Address - Country:US
Practice Address - Phone:617-855-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor