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General NPI Number Information
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NPI Number | 1538072418
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Entity Type | Individual
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Provider Name | JACOB GUBERMAN
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Gender | Male
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 2701 NE 21ST ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33305-3614
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Country | US
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Telephone | 954-830-9508
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Fax |
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Provider Business Mailing Address
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Address Line | 11523 LOVEJOY ST
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City | SILVER SPRING
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State | MD
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Zip | 20902-3145
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Country | US
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Telephone | 301-335-8290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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