Provider Demographics
NPI:1275826729
Name:DR. ALEX JACOBSON PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:DR. ALEX JACOBSON PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JAURS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-892-4213
Mailing Address - Street 1:103 GLENCOE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2055
Mailing Address - Country:US
Mailing Address - Phone:302-996-5480
Mailing Address - Fax:302-636-9473
Practice Address - Street 1:103 GLENCOE COURT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-996-5480
Practice Address - Fax:302-636-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE115017459283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE182558Medicare Oscar/Certification