Provider Demographics
NPI:1861664302
Name:JACOBS, MARTA ROSA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:ROSA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 PASSION VINE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3659
Mailing Address - Country:US
Mailing Address - Phone:305-336-9714
Mailing Address - Fax:
Practice Address - Street 1:1599 PASSION VINE CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3659
Practice Address - Country:US
Practice Address - Phone:305-336-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6624103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist