Provider Demographics
NPI:1780674044
Name:JACOBSEN, BARRIE ROBIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARRIE
Middle Name:ROBIN
Last Name:JACOBSEN
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 1:600 MAPLE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1436
Mailing Address - Country:US
Mailing Address - Phone:570-253-1005
Mailing Address - Fax:
Practice Address - Street 1:600 MAPLE AVE STE 3
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1436
Practice Address - Country:US
Practice Address - Phone:570-253-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0184311041C0700X
NY0694891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical