Provider Demographics
NPI:1558936971
Name:JACOBSON, REBECCA JANE (LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-4709
Mailing Address - Country:US
Mailing Address - Phone:321-591-1316
Mailing Address - Fax:
Practice Address - Street 1:4010 ADAMS LN
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-4709
Practice Address - Country:US
Practice Address - Phone:321-591-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty