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General NPI Number Information
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NPI Number | 1568845188
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Entity Type | Individual
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Provider Name | CAROLYN M JACOBY LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 4850 S THOMPSON AVE
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City | TACOMA
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State | WA
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Zip | 98408
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Country | US
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Telephone | 941-600-6656
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 S THOMPSON AVE
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City | TACOMA
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State | WA
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Zip | 98408-5733
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Country | US
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Telephone | 941-600-6656
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11574
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60614321
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License Number State | WA
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