Active NPI
Lisa Marion Jacobs, PHD
- Psychologist
- Summit, NJ
National Provider Identifier
1104958305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 55 Woodland Ave
Summit, NJ 07901-2112 - Phone
- (908) 598-0870
- Fax
- (908) 522-6668
- NPI assigned
- Mar 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
55 Woodland Ave
Summit, NJ 07901-2112
Mailing address
55 Woodland Ave
Summit, NJ 07901-2112
Phone (908) 598-0870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 18, 2012 through May 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104958305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 WOODLAND AVE",
"city": "SUMMIT",
"state": "NJ",
"postal_code": "079012112",
"telephone_number": "908-598-0870",
"fax_number": "908-522-6668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 WOODLAND AVE",
"city": "SUMMIT",
"state": "NJ",
"postal_code": "079012112",
"telephone_number": "908-598-0870",
"fax_number": "908-522-6668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "LISA",
"middle_name": "MARION",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summit, NJ
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.