Healthcare Provider Details

I. General information

NPI: 1225283013
Provider Name (Legal Business Name): MELISSA JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1387 CHEWS LANDING RD
CLEMENTON NJ
08021-2760
US

IV. Provider business mailing address

9 CLAREMONT AVE
LIVINGSTON NJ
07039-2705
US

V. Phone/Fax

Practice location:
  • Phone: 856-454-3104
  • Fax: 856-842-5298
Mailing address:
  • Phone: 973-462-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05212900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: