Provider Demographics
NPI:1801914684
Name:JACOBSEN, RUTH ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELIZABETH
Last Name:JACOBSEN
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95017-0206
Mailing Address - Country:US
Mailing Address - Phone:831-425-3113
Mailing Address - Fax:
Practice Address - Street 1:157 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4200
Practice Address - Country:US
Practice Address - Phone:831-425-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 197271041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool