Provider Demographics
NPI:1265573729
Name:SHERYL R. JACOBS, PH.D., P.C.
Entity type:Organization
Organization Name:SHERYL R. JACOBS, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-580-9045
Mailing Address - Street 1:6 RESERVOIR CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-7300
Mailing Address - Country:US
Mailing Address - Phone:410-580-9045
Mailing Address - Fax:410-580-9046
Practice Address - Street 1:6 RESERVOIR CIR STE 201
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-7300
Practice Address - Country:US
Practice Address - Phone:410-580-9045
Practice Address - Fax:410-580-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2899103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD006499OtherVALUE OPTIONS
MD46365OtherCIGNA
MD373857OtherTRICARE
MD157959OtherMHN
MD218020OtherKAISER PERMANENTE
MD22877OtherJOHNS HOPKINS UNIVERSITY
MD373857OtherTRICARE