Provider Demographics
NPI:1194764605
Name:JAKUBOWSKI, SUSAN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:JAKUBOWSKI
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 1:347 NORTH PIKE ROAD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055
Mailing Address - Country:US
Mailing Address - Phone:724-448-2049
Mailing Address - Fax:724-353-9901
Practice Address - Street 1:347 NORTH PIKE ROAD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055
Practice Address - Country:US
Practice Address - Phone:724-448-2049
Practice Address - Fax:724-353-9901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
163979OtherVALUE OPTIONS VBH
00628800OtherHIGHMARK
PA1013320170001Medicaid
056687OtherMAGELLAN
056687OtherMAGELLAN