Organization
DEBORAH M. JACOB, PSY.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH M JACOB PSY.D. (PSYCHOLOGIST)
(856) 691-1511
Entity
Organization
Contact information
Practice address
1138 E CHESTNUT AVE, BUILDING 6 SUITE C, VINELAND, NJ 08360-5053
(856) 691-1511
(856) 696-8517
Mailing address
1138 E CHESTNUT AVE, BUILDING 6 SUITE C, VINELAND, NJ 08360-5053
(856) 691-1511
(856) 696-8517
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
35SI00329800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093679
MEDICARE ID
NJ
Enumeration date
02/05/2008
Last updated
02/05/2008
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