Provider Demographics
NPI:1316401904
Name:JACOBS, KATERINA
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NEW BRITAIN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2448
Mailing Address - Country:US
Mailing Address - Phone:860-310-7113
Mailing Address - Fax:858-924-0244
Practice Address - Street 1:1100 NEW BRITAIN AVE STE 107
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2448
Practice Address - Country:US
Practice Address - Phone:860-310-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst