Provider Demographics
NPI:1639444227
Name:JACOBS, JILLIAN NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:NICOLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1552
Mailing Address - Country:US
Mailing Address - Phone:860-793-7245
Mailing Address - Fax:860-793-3369
Practice Address - Street 1:91 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1552
Practice Address - Country:US
Practice Address - Phone:860-793-7245
Practice Address - Fax:860-793-3369
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054843001041C0700X
CT99591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical