Provider Demographics
NPI:1821162678
Name:JACOBS, JANICE LYONS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LYONS
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 CARMEL CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5544
Mailing Address - Country:US
Mailing Address - Phone:561-302-0887
Mailing Address - Fax:
Practice Address - Street 1:7035 BERACASA WAY STE 201
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3408
Practice Address - Country:US
Practice Address - Phone:561-302-0887
Practice Address - Fax:561-419-6586
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical