Provider Demographics
NPI:1568528255
Name:JACOBS, JAMES HARRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARRIS
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1009
Mailing Address - Country:US
Mailing Address - Phone:510-524-9058
Mailing Address - Fax:510-527-2422
Practice Address - Street 1:1708 SHATTUCK AVENUE #2
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709
Practice Address - Country:US
Practice Address - Phone:510-841-6058
Practice Address - Fax:510-527-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL57480Medicare UPIN
CA00PL57480Medicare ID - Type Unspecified