Healthcare Provider Details

I. General information

NPI: 1265562797
Provider Name (Legal Business Name): FRANK JOSEPH JACOBELLI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75C DIAMOND VALLEY RD ALPINE COUNTY BEHAVIORAL HEALTH SERVICES
MARKLEEVILLE CA
96120
US

IV. Provider business mailing address

820 MUSTANG LN
GARDNERVILLE NV
89410
US

V. Phone/Fax

Practice location:
  • Phone: 530-694-1816
  • Fax: 530-694-2387
Mailing address:
  • Phone: 775-265-0065
  • Fax: 775-265-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01886-C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS 13346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: