Provider Demographics
NPI:1154861185
Name:JACOBS, JUDITH ANN (LMFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-5621
Mailing Address - Country:US
Mailing Address - Phone:954-785-8285
Mailing Address - Fax:954-784-2756
Practice Address - Street 1:8400 N UNIVERSITY DR STE 209
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-880-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMT2016OtherRMFTI
FLIMT2106OtherRMFTI