Provider Demographics
NPI:1114047891
Name:JACOBS, JEANETTE STEWART (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:STEWART
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JEANETTE
Other - Middle Name:S
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:627 N GRANDVIEW AVE STE 242
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3806
Mailing Address - Country:US
Mailing Address - Phone:570-404-4740
Mailing Address - Fax:386-943-9937
Practice Address - Street 1:627 N GRANDVIEW AVE STE 242
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3806
Practice Address - Country:US
Practice Address - Phone:570-404-4740
Practice Address - Fax:855-856-5818
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical