Provider Demographics
NPI:1801818984
Name:JACOBS, NEGAR NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEGAR
Middle Name:NICOLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:401 WEST 2ND STREET
Mailing Address - Street 2:#235D
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-682-8175
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:5190 NEIL RD
Practice Address - Street 2:215
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6599
Practice Address - Country:US
Practice Address - Phone:775-784-4917
Practice Address - Fax:775-784-1428
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPY0501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAV745ZMedicare PIN