Individual
DR. MARK PETER JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., LICSW
Contact information
Practice address
2607 CONNECTICUT AVE NW, WASHINGTON, DC 20008-1522
(703) 521-1710
Mailing address
2607 CONNECTICUT AVE NW, WASHINGTON, DC 20008-1522
(703) 521-1710
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
06666
MD
1041C0700X
Clinical Social Worker
0904004705
VA
1041C0700X
Clinical Social Worker
Primary
LC303458
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001J475
BC/BS
DC
Enumeration date
02/21/2008
Last updated
02/21/2008
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