Provider Demographics
NPI:1407938103
Name:JACOBS FISTANIC, BARBARA (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JACOBS FISTANIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:13323 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-740-6500
Mailing Address - Fax:
Practice Address - Street 1:13323 WASHINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:310-740-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS197371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical