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General NPI Number Information
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NPI Number | 1639672876
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Entity Type | Individual
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Provider Name | JACOB JOSEPH THOMAS MA, BCBA
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Gender | Male
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 81 VERNON ST APT 210
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City | OAKLAND
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State | CA
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Zip | 94610-4246
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Country | US
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Telephone | 925-324-9599
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Fax |
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Provider Business Mailing Address
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Address Line | 3745 LONG BEACH BLVD STE 100
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City | LONG BEACH
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State | CA
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Zip | 90807-3340
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Country | US
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Telephone | 866-523-4268
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Fax | 510-900-4310
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-73714
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License Number State | CA
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