Provider Demographics
NPI:1578843686
Name:JACOBO, ELIZABETH PENELOPE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PENELOPE
Last Name:JACOBO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:PENELOPE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1802 WIND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4132
Mailing Address - Country:US
Mailing Address - Phone:619-203-9870
Mailing Address - Fax:
Practice Address - Street 1:8530 LA MESA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:323-798-7413
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA806141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578843686OtherN/A