Provider Demographics
NPI:1467550194
Name:JACOBS, MERYL GOLDSTEIN (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:GOLDSTEIN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:MRS
Other - First Name:MERYL
Other - Middle Name:ELYSE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LPC
Mailing Address - Street 1:22 WINDHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642
Mailing Address - Country:US
Mailing Address - Phone:201-722-2533
Mailing Address - Fax:201-722-0083
Practice Address - Street 1:223 OLD HOOK ROAD
Practice Address - Street 2:PASCACK MEDICAL CENTER
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-722-2533
Practice Address - Fax:201-722-0083
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017731101YM0800X
NJ37PC00174700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional