Provider Demographics
NPI:1427065218
Name:JACOBSON, ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 COTTAGE ST
Practice Address - Street 2:SUITE 5-F
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2153
Practice Address - Country:US
Practice Address - Phone:617-680-5488
Practice Address - Fax:781-320-1994
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical