Individual
RONALD STEWART JACOBSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2580 POTTERS RD, VIRGINIA BEACH, VA 23454-4324
(757) 498-9391
(757) 498-7073
Mailing address
2580 POTTERS RD, VIRGINIA BEACH, VA 23454-4324
(757) 498-9391
(757) 498-7073
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810000305
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00704143
—
VA
01
—
257774
ANTHEM BCBS
VA
01
—
O83564
SENTARA/OPTIMA HEALTH CAR
VA
Enumeration date
05/19/2006
Last updated
07/09/2007
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