Healthcare Provider Details

I. General information

NPI: 1265573729
Provider Name (Legal Business Name): SHERYL R. JACOBS, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RESERVOIR CIR STE 201
BALTIMORE MD
21208-7300
US

IV. Provider business mailing address

6 RESERVOIR CIR STE 201
BALTIMORE MD
21208-7300
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-9045
  • Fax: 410-580-9046
Mailing address:
  • Phone: 410-580-9045
  • Fax: 410-580-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2899
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2899
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2899
License Number StateMD

VIII. Authorized Official

Name: DR. SHERYL R JACOBS
Title or Position: DIRECTOR
Credential:
Phone: 410-580-9045