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Individual

DR. GREGG D JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
85 PRESCOTT ST, WORCESTER, MA 01605-2610
(508) 793-4958
(508) 334-8127
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4595
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0520152
MA
05
110023549A
MA
Enumeration date
10/04/2006
Last updated
01/25/2017
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