Provider Demographics
NPI:1811403538
Name:JACOB, NEENA MARY (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:NEENA
Middle Name:MARY
Last Name:JACOB
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 TOMLINSON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3339
Mailing Address - Country:US
Mailing Address - Phone:703-717-3555
Mailing Address - Fax:
Practice Address - Street 1:7226 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1108
Practice Address - Country:US
Practice Address - Phone:215-742-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker