Provider Demographics
NPI:1801954755
Name:JACOBSON, SHIRLEY D (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:D
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 OLD CONNECTICUT PATH
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3114
Mailing Address - Country:US
Mailing Address - Phone:508-358-7872
Mailing Address - Fax:
Practice Address - Street 1:11 CHAPEL PL
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3130
Practice Address - Country:US
Practice Address - Phone:781-235-4950
Practice Address - Fax:781-235-7176
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical