Provider Demographics
NPI:1740031434
Name:JACOBY, JULIE FISHER (MA, PPS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:FISHER
Last Name:JACOBY
Suffix:
Gender:F
Credentials:MA, PPS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PPS
Mailing Address - Street 1:17520 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1434
Mailing Address - Country:US
Mailing Address - Phone:510-736-3198
Mailing Address - Fax:
Practice Address - Street 1:17520 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-1434
Practice Address - Country:US
Practice Address - Phone:510-537-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool