Provider Demographics
NPI:1942409727
Name:JACOBS, JEFFREY ROLNALD
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROLNALD
Last Name:JACOBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3221
Mailing Address - Country:US
Mailing Address - Phone:310-821-4189
Mailing Address - Fax:
Practice Address - Street 1:3231 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3221
Practice Address - Country:US
Practice Address - Phone:310-821-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16089103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist