Provider Demographics
NPI:1376173377
Name:JACOBS, JACLYN (MS, CRC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LOCUST ST APT 1515
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4315
Mailing Address - Country:US
Mailing Address - Phone:304-549-4215
Mailing Address - Fax:
Practice Address - Street 1:401 S 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1612
Practice Address - Country:US
Practice Address - Phone:267-388-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health