Healthcare Provider Details

I. General information

NPI: 1144139965
Provider Name (Legal Business Name): RYAN J. JACOBY, PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CAMBRIDGE ST STE 2000
BOSTON MA
02114-2790
US

IV. Provider business mailing address

185 CAMBRIDGE ST STE 2000
BOSTON MA
02114-2790
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4167
  • Fax:
Mailing address:
  • Phone: 617-724-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN JANE JACOBY
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 617-724-4167