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NPI Code Detail

MEDICARE: MS. CAREY ANNE JACOBS LICSW

MEDICARE: MS. CAREY ANNE JACOBS LICSW
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
11041C0700XClinical Social Worker110470MA

General Provider Information

NPI Number : 1578599015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAREY ANNE JACOBS LICSW
Provider Business Mailing Address
First Line : 230 BROADWAY
Second Line :
City : SOMERVILLE
State : MA
Zip : 02145-3015
Country : US
Telephone Number : 617-835-2240
Fax Number :
Provider Business Practice Location Address
First Line : 64 ELDREDGE ST
Second Line :
City : NEWTON
State : MA
Zip : 02458-2017
Country : US
Telephone Number : 617-969-4925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 07/08/2007

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