| Cecilia Jacobs, Psy.d., Llc | |
|
2188 Gateway Dr Fairborn OH 45324-6356 | |
| (937) 320-5859 | |
| (937) 426-1349 |
| Full Name | Cecilia Jacobs, Psy.d., Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2188 Gateway Dr, Fairborn, Ohio |
| Authorized Official Name and Position | Cecilia Jacobs (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9373205859 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cecilia Jacobs, Psy.d., Llc 2188 Gateway Dr Fairborn OH 45324-6356 Ph: (937) 320-5859 | Cecilia Jacobs, Psy.d., Llc 2188 Gateway Dr Fairborn OH 45324-6356 Ph: (937) 320-5859 |
| NPI Number | 1134392814 |
|---|---|
| Provider Enumeration Date | 04/02/2008 |
| Last Update Date | 04/02/2008 |
| Medicare PECOS PAC ID | 0345267365 |
|---|---|
| Medicare Enrollment ID | O20051028000916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134392814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 5332 (Ohio) | Primary |
| Provider Name | Cecilia Dine Jacobs |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356333678 PECOS PAC ID: 4486645348 Enrollment ID: I20040519001398 |
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