Provider Demographics
NPI:1316006448
Name:JACOBS, BETH T (LISW)
Entity type:Individual
Prefix:MR
First Name:BETH
Middle Name:T
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GREY FOX RUN
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3392
Mailing Address - Country:US
Mailing Address - Phone:440-247-5297
Mailing Address - Fax:
Practice Address - Street 1:11565 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3356
Practice Address - Country:US
Practice Address - Phone:440-846-0862
Practice Address - Fax:440-846-0890
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00056061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical