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NPI Code Detail

MEDICARE: JULIE JACOBS PHD

MEDICARE: JULIE JACOBS PHD
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
1103T00000XPsychologistPS015047PA

General Provider Information

NPI Number : 1588876668
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE JACOBS PHD
Provider Business Mailing Address
First Line : 1528 WALNUT ST STE 1203
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-3609
Country : US
Telephone Number : 215-888-0662
Fax Number :
Provider Business Practice Location Address
First Line : 1528 WALNUT ST STE 1203
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-3609
Country : US
Telephone Number : 215-888-0662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 08/12/2009

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Directions to “ JULIE JACOBS PHD” Practice Location

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