Provider Demographics
NPI:1962546093
Name:JACOBSON, MELISSA SMILEY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SMILEY
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 FAIRSTEAD LANE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217
Mailing Address - Country:US
Mailing Address - Phone:412-521-4088
Mailing Address - Fax:
Practice Address - Street 1:4070 BEECHWOOD BLVD
Practice Address - Street 2:PEDIATRIC ANEX - UNIT 6
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2679
Practice Address - Country:US
Practice Address - Phone:412-519-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0141091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1365356OtherHIGHMARK BLUE CROSS #