Provider Demographics
NPI:1801205349
Name:JACOBSON, NATSUKO (LCSW)
Entity type:Individual
Prefix:
First Name:NATSUKO
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4175
Mailing Address - Country:US
Mailing Address - Phone:232-416-7303
Mailing Address - Fax:323-967-0614
Practice Address - Street 1:1045 W REDONDO BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4175
Practice Address - Country:US
Practice Address - Phone:323-241-6730
Practice Address - Fax:323-967-0614
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS952441041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program