Provider Demographics
NPI:1841733904
Name:LINDA GIACOBBE
Entity type:Organization
Organization Name:LINDA GIACOBBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIACOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-886-4886
Mailing Address - Street 1:4609 HWY 17, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-886-4886
Mailing Address - Fax:
Practice Address - Street 1:4609 HWY 17, SUITE 1
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-886-4886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5151251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health