Provider Demographics
NPI:1689852956
Name:JACOBSON, MICHELLE C (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:JACOBSON
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 1:3151 E COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8217
Mailing Address - Country:US
Mailing Address - Phone:561-371-1885
Mailing Address - Fax:561-624-6137
Practice Address - Street 1:4360 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6274
Practice Address - Country:US
Practice Address - Phone:561-371-1885
Practice Address - Fax:561-624-6137
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW30331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5084OtherBLUE CROSS/BLUE SHIELD