Susan Charlotte Jacobsen, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MHC00294 Issued in RI

Practice address

64 Indian Run TRL
Wakefield, RI 02879-1908

Phone

(401) 742-1430

NPI assigned

Feb 9, 2007

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013058320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 INDIAN RUN TRL",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028791908",
            "telephone_number": "401-742-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 INDIAN RUN TRL",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028791908",
            "telephone_number": "401-742-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "SUSAN",
        "middle_name": "CHARLOTTE",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "MHC00294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Raymond Iannuccilli, OD
• Savannah Iasimone
• Innovative Works
• Elizabeth Bogardus Ison, LICSW SOCIAL WORKER
• Sherry Jackson, LICSW
• James F. Griffin
• Elise N Jarvis
• Jee Q. Liang, M.D
• Caroline H. Jenckes, CRNP
• John D. Graham M.D.

• All providers in Wakefield, RI
• Mental Health Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.