Provider Demographics
NPI:1336196716
Name:JACOBSON, JONATHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:148 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1751
Mailing Address - Country:US
Mailing Address - Phone:508-835-1735
Mailing Address - Fax:508-835-1736
Practice Address - Street 1:148 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1751
Practice Address - Country:US
Practice Address - Phone:508-835-1735
Practice Address - Fax:508-835-1736
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2279132084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry