Provider Demographics
NPI:1346382041
Name:JACOBUS, STEPHANE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANE
Middle Name:
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2137
Mailing Address - Country:US
Mailing Address - Phone:413-794-7035
Mailing Address - Fax:
Practice Address - Street 1:BAYSTATE ADULT BEHAVIORAL HEALTH
Practice Address - Street 2:3300 MAIN STREET, SUITE 3D
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0001
Practice Address - Country:US
Practice Address - Phone:413-794-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical