MEDICARE: MATTHEW JACOBS LSW

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	1041C0700X	Clinical Social Worker	44SL05938200	NJ

General Provider Information

NPI Number	:	1558804906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JACOBS LSW

Provider Business Mailing Address
First Line	:	3 ISAACS LN
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7354
Country	:	US
Telephone Number	:	609-846-5653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 ISAACS LN
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7354
Country	:	US
Telephone Number	:	609-846-5653
Fax Number	:

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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