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1629461314 NPI number — JOSEPH DANIEL JACOBS PHD, BCBA-D

NPI Number: 1629461314
Health Care Provider/Practitioner: JOSEPH DANIEL JACOBS PHD, BCBA-D

Information about “1629461314” NPI (JOSEPH DANIEL JACOBS PHD, BCBA-D) exists in 1629461314 in HTML format HTML  |  1629461314 in plain Text format TXT  |  1629461314 in PDF (Portable Document Format) PDF  |  1629461314 in an XML format XML  formats.

NPI Number : 1629461314 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629461314",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACOBS",
    "FirstName": "JOSEPH",
    "MiddleName": "DANIEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD, BCBA-D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16350 VENTURA BLVD STE D147",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ENCINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91436-5300",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-957-5126",
    "MailingAddressFaxNumber": "818-654-6536",
    "FirstLinePracticeLocationAddress": "12304 SANTA MONICA BLVD STE 315",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90025-2551",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-957-5126",
    "PracticeLocationAddressFaxNumber": "323-272-4076",
    "EnumerationDate": "03/05/2015",
    "LastUpdateDate": "03/26/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "PSY33549",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSY33549",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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