Provider Demographics
NPI:1205424629
Name:JACOBS, SHEVA Y (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHEVA
Middle Name:Y
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHEVY
Other - Middle Name:Y
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2409 VILLAGE GREEN CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-0991
Mailing Address - Country:US
Mailing Address - Phone:347-760-8414
Mailing Address - Fax:
Practice Address - Street 1:2409 VILLAGE GREEN CT
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-0991
Practice Address - Country:US
Practice Address - Phone:347-760-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06053100104100000X
NJ44SC060533001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid