Provider Demographics
NPI:1518593169
Name:JACOBELLI, GIANNA LISA
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:LISA
Last Name:JACOBELLI
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 1:626 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2004
Mailing Address - Country:US
Mailing Address - Phone:201-240-1063
Mailing Address - Fax:
Practice Address - Street 1:626 ADAMS ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2004
Practice Address - Country:US
Practice Address - Phone:201-240-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports