MEDICARE: ERIC JACOBSON

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	103TB0200X	Cognitive & Behavioral Psychologist	PS015808	PA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PS015808	PA

General Provider Information

NPI Number	:	1841332715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JACOBSON

Provider Business Mailing Address
First Line	:	222 STONEWAY LN
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 FORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2824
Country	:	US
Telephone Number	:	215-643-5400
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	09/11/2025

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