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General NPI Number Information
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NPI Number | 1780274977
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Entity Type | Individual
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Provider Name | PROF. JILL BERGER JACOBSON
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Gender | Female
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 3208 BENJAMIN BUILDING
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City | COLLEGE PARK
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State | MD
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Zip | 20742-1108
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Country | US
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Telephone | 301-405-0687
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Fax |
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Provider Business Mailing Address
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Address Line | 12729 LINCOLNSHIRE DR
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City | POTOMAC
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State | MD
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Zip | 20854-2364
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Country | US
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Telephone | 757-621-5621
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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