Provider Demographics
NPI:1689852402
Name:JACOBS, SHELLEY M (LCSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 US ROUTE 1 STE 2
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7219
Mailing Address - Country:US
Mailing Address - Phone:207-396-7606
Mailing Address - Fax:207-819-6802
Practice Address - Street 1:144 US ROUTE 1 STE 2
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7219
Practice Address - Country:US
Practice Address - Phone:207-396-7606
Practice Address - Fax:207-819-6802
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC113701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical