MEDICARE: LEE-ANNE JACOBS

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

General Provider Information

NPI Number	:	1932686250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE-ANNE JACOBS

Provider Business Mailing Address
First Line	:	155 KENDRICK AVE APT 207
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-7903
Country	:	US
Telephone Number	:	617-328-5873
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HANCOCK ST FL 7
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-1745
Country	:	US
Telephone Number	:	617-847-3731
Fax Number	:

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

Provider Enumeration Date	:	07/20/2018
Last Update Date	:	07/20/2018

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Directions to “ LEE-ANNE JACOBS ” Practice Location

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