Provider Demographics
NPI:1417144056
Name:JACOBSON, BEVERLY J
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:J
Last Name:JACOBSON
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 1:1187 COAST VILLAGE RD
Mailing Address - Street 2:SUITE 531
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2737
Mailing Address - Country:US
Mailing Address - Phone:805-455-1012
Mailing Address - Fax:
Practice Address - Street 1:1187 COAST VILLAGE RD
Practice Address - Street 2:SUITE 531
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2737
Practice Address - Country:US
Practice Address - Phone:805-455-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)