MEDICARE: ZOE GRACE JACOB LMHC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427778877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE GRACE JACOB LMHC

Provider Business Mailing Address
First Line	:	49 PAUL GORE ST UNIT 2
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02130-1838
Country	:	US
Telephone Number	:	630-346-1275
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 WASHINGTON ST
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1817
Country	:	US
Telephone Number	:	781-400-3232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	06/03/2026

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