Provider Demographics
NPI:1235368853
Name:JACOBSON, LAWRENCE MITCHELL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MITCHELL
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 CALIFORNIA AVE SW
Mailing Address - Street 2:#301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1677
Mailing Address - Country:US
Mailing Address - Phone:206-232-6300
Mailing Address - Fax:
Practice Address - Street 1:1613 CALIFORNIA AVE SW
Practice Address - Street 2:#301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-1677
Practice Address - Country:US
Practice Address - Phone:206-232-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000074481041C0700X
CALCS 113291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical