Provider Demographics
NPI:1245384635
Name:JACOBSEN, MARY H (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7823
Mailing Address - Country:US
Mailing Address - Phone:781-646-8918
Mailing Address - Fax:781-646-8918
Practice Address - Street 1:259 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:781-646-8918
Practice Address - Fax:781-646-8918
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW10147891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical