MEDICARE: MEGHAN JACOBS, PSY.D., PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PSY8252	FL

General Provider Information

NPI Number	:	1194001917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGHAN JACOBS, PSY.D., PA

Provider Business Mailing Address
First Line	:	6941 BRUCE CT
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 KNUTH RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4629
Country	:	US
Telephone Number	:	954-895-1812
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. MEGHAN JACOBS
Credential	:
Telephone Number	:	954-895-1812

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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