Provider Demographics
NPI:1588713978
Name:JACOBS, JAMES LELAND (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LELAND
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:NORTH VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04962-0348
Mailing Address - Country:US
Mailing Address - Phone:207-217-4362
Mailing Address - Fax:
Practice Address - Street 1:123 MUDGET HILL RD
Practice Address - Street 2:
Practice Address - City:VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04989-4305
Practice Address - Country:US
Practice Address - Phone:207-445-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS600103TC2200X, 103TF0200X, 103TR0400X, 103TC0700X, 103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME143490000Medicaid
ME143490000Medicaid