Provider Demographics
NPI:1932686250
Name:JACOBS, LEE-ANNE
Entity Type:Individual
Prefix:
First Name:LEE-ANNE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 KENDRICK AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7903
Mailing Address - Country:US
Mailing Address - Phone:617-328-5873
Mailing Address - Fax:
Practice Address - Street 1:100 HANCOCK ST FL 7
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1745
Practice Address - Country:US
Practice Address - Phone:617-847-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical