Provider Demographics
NPI:1477096816
Name:JACOBS, EMILY (MS, MSW, LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS, MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1014
Mailing Address - Country:US
Mailing Address - Phone:518-414-4098
Mailing Address - Fax:
Practice Address - Street 1:587 SHORE RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-1014
Practice Address - Country:US
Practice Address - Phone:518-414-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC200111041C0700X, 101YM0800X
MA1239501041C0700X
1041C0700X
ME1041C0700X
NY099344101YM0800X
NH2474101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty