Provider Demographics
NPI:1457650673
Name:JACOBS, MEGHAN KELLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:KELLY
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:KELLY
Other - Last Name:DURKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6941 BRUCE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7469
Mailing Address - Country:US
Mailing Address - Phone:954-895-1812
Mailing Address - Fax:954-315-7939
Practice Address - Street 1:9970 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2231
Practice Address - Country:US
Practice Address - Phone:561-245-4622
Practice Address - Fax:561-613-6476
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8252103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical