Active NPI
Kelly B Jacobson, PH.D.
- Counseling Psychologist
- Winter Park, FL
National Provider Identifier
1023231032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- PY 0007292
- Practice address
- 1850 Lee Rd
Suite 234
Winter Park, FL 32789-2115 - Phone
- (407) 678-0100
- NPI assigned
- Apr 10, 2007
- Last updated
- Sep 1, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PY 0007292 | FL | Primary |
Addresses
Primary practice location
1850 Lee Rd
Suite 234
Winter Park, FL 32789-2115
Mailing address
1850 Lee Rd
Suite 234
Winter Park, FL 32789-2115
Phone (407) 678-0100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 0007292 | FL | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251763200000",
"number": "1023231032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1850 LEE RD",
"address_2": "SUITE 234",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327892115",
"telephone_number": "407-678-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 LEE RD",
"address_2": "SUITE 234",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327892115",
"telephone_number": "407-678-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "KELLY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2009-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "FL",
"license": "PY 0007292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.