Provider Demographics
NPI:1881819944
Name:JACOBUS, STEPHEN F (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:JACOBUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-5030
Mailing Address - Country:US
Mailing Address - Phone:908-534-1233
Mailing Address - Fax:
Practice Address - Street 1:250 STATE ROUTE 28
Practice Address - Street 2:SUITE 206
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1979
Practice Address - Country:US
Practice Address - Phone:908-534-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3693103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist