Provider Demographics
NPI:1063541977
Name:JACOBSON, SUSAN E (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:LOFTUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CS, NP
Mailing Address - Street 1:4131 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1018
Mailing Address - Country:US
Mailing Address - Phone:703-289-7560
Mailing Address - Fax:703-289-4612
Practice Address - Street 1:3020 JAVIER RD
Practice Address - Street 2:INOVA BEHAVIORAL HEALTH
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4609
Practice Address - Country:US
Practice Address - Phone:703-289-7585
Practice Address - Fax:703-289-4612
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001500246163WP0809X
VA0024167284363LP0808X
VA0015000246364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult