Provider Demographics
NPI:1497467179
Name:JACOBS, REBECCA (LCSW - C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E DIAMOND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-5321
Mailing Address - Country:US
Mailing Address - Phone:301-840-3200
Mailing Address - Fax:
Practice Address - Street 1:610 E DIAMOND AVE STE 100
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5321
Practice Address - Country:US
Practice Address - Phone:301-466-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD232471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical