Provider Demographics
NPI:1114299351
Name:JACOBSON, LILI RACHEL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LILI
Middle Name:RACHEL
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CLARKEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3456
Mailing Address - Country:US
Mailing Address - Phone:973-985-3800
Mailing Address - Fax:
Practice Address - Street 1:17 HANOVER RD
Practice Address - Street 2:BUILDING 300
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1411
Practice Address - Country:US
Practice Address - Phone:973-985-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00407200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional