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NPI Code Detail

MEDICARE: MATTHEW JACOBS LSW

MEDICARE:   MATTHEW  JACOBS  LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SL05938200NJ

General Provider Information

NPI Number : 1558804906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JACOBS LSW
Provider Business Mailing Address
First Line : 3 ISAACS LN
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-7354
Country : US
Telephone Number : 609-846-5653
Fax Number :
Provider Business Practice Location Address
First Line : 3 ISAACS LN
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-7354
Country : US
Telephone Number : 609-846-5653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2016
Last Update Date : 12/01/2016

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