Provider Demographics
NPI:1801865977
Name:JACOBSON, TARA ELIZABETH (BS)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ELIZABETH
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:BS
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Mailing Address - Street 1:2210 S TAMIAMI TRAIL
Mailing Address - Street 2:#10
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:941-497-7742
Mailing Address - Fax:941-497-7683
Practice Address - Street 1:2210 S TAMIAMI TRAIL
Practice Address - Street 2:#10
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-497-7742
Practice Address - Fax:941-497-7683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)