Provider Demographics
NPI:1720122526
Name:JACOBELLIS, PATRICIA (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:JACOBELLIS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAIN STREET
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-681-0022
Mailing Address - Fax:603-681-0567
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:SUITE 203B
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3176
Practice Address - Country:US
Practice Address - Phone:603-681-0022
Practice Address - Fax:603-681-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health