MEDICARE: DR. HARVEY EARL JACOBS PH.D.

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	103T00000X	Psychologist	3198	NC
2	103TC0700X	Clinical Psychologist	0810-002607	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497722789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARVEY EARL JACOBS PH.D.

Provider Business Mailing Address
First Line	:	3990 REEDS LANDING CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-1385
Country	:	US
Telephone Number	:	804-814-0609
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 BEAUFONT SPRINGS DR
Second Line	:	SUITE 401
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5556
Country	:	US
Telephone Number	:	804-323-5560
Fax Number	:	804-323-5562

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

Provider Enumeration Date	:	03/05/2006
Last Update Date	:	11/28/2012

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