Provider Demographics
NPI:1780274977
Name:JACOBSON, JILL BERGER
Entity type:Individual
Prefix:PROF
First Name:JILL
Middle Name:BERGER
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12729 LINCOLNSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2364
Mailing Address - Country:US
Mailing Address - Phone:757-621-5621
Mailing Address - Fax:
Practice Address - Street 1:3208 BENJAMIN BUILDING
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-1108
Practice Address - Country:US
Practice Address - Phone:301-405-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool