Provider Demographics
NPI:1215929351
Name:JACOBSON, JODI G (LCSW DCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:G
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LCSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 GLADES RD STE 209
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3958
Mailing Address - Country:US
Mailing Address - Phone:561-289-2573
Mailing Address - Fax:561-883-3739
Practice Address - Street 1:9250 GLADES RD STE 209
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-391-4669
Practice Address - Fax:561-391-1815
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002936104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z4647AMedicare ID - Type Unspecified