Jerrold Jacobson, BCBA CAP LMHC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-01-0707 Issued in FL

Practice address

7422 SW Horse Creek Rd
Arcadia, FL 34266-8894

Phone

(863) 494-9251

Fax

(863) 494-9251

NPI assigned

Dec 31, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

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.

{
    "created_epoch": "1293753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293753600000",
    "number": "1033413315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7422 SW HORSE CREEK RD",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668894",
            "telephone_number": "863-494-9251",
            "fax_number": "863-494-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7422 SW HORSE CREEK RD",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668894",
            "telephone_number": "863-494-9251",
            "fax_number": "863-494-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "JERROLD",
        "credential": "BCBA CAP LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-31",
        "last_updated": "2010-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "2389",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 4420",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-01-0707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676127598",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676127596",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ironhead Ranch, Inc.
• Rodney L Izzo, LCSW
• Jenice Antoinette Jackson
• Keosha Jackson
• Regginald Jackson
• Beverly Jean-Jacques, PH.D.
• Daphney S Jean, ULTRASOUND TECH.
• Gerda L Jean, OT
• JJ Transport of Arcadia, Inc.
• Priscille M Joglar Pagan, PSYD

• Behavior Analyst in Arcadia, FL
• Providers in Arcadia, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2010; 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.