Provider Demographics
NPI:1114961752
Name:JACOBS, DANIEL B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HEROLD RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3314
Mailing Address - Country:US
Mailing Address - Phone:978-985-5532
Mailing Address - Fax:978-475-1181
Practice Address - Street 1:1 ELM SQ
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3643
Practice Address - Country:US
Practice Address - Phone:978-470-0520
Practice Address - Fax:978-475-1181
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJAW51345Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER