Cecilia Jacobs, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5332 Issued in OH

Practice address

2188 Gateway Dr
Fairborn, OH 45324-6356

Phone

(937) 320-5859

Fax

(937) 426-1349

NPI assigned

Aug 22, 2005

Last updated

Mar 27, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cecilia Jacobs, Psy.D., LLC

  • Community/Behavioral Health Agency
  • Fairborn, OH
  • NPI 1134392814
  Medicare reassignment NPD Authorized official
• Kathy Acus-Souders, Psy.D., LLC

  • Clinical Psychologist
  • Fairborn, OH
  • NPI 1215112214
  NPD (past)
• Professional Psychology & Consultation Inc

  • Social Worker
  • Dayton, OH
  • NPI 1477613453
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206576000000",
    "number": "1356333678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2188 GATEWAY DR",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246356",
            "telephone_number": "937-320-5859",
            "fax_number": "937-426-1349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2188 GATEWAY DR",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246356",
            "telephone_number": "937-320-5859",
            "fax_number": "937-426-1349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "CECILIA",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-22",
        "last_updated": "2008-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "5332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intecare, Inc. (InteCare Medical Clinic)
• Intecare, Inc. (InteCare Medical Clinic)
• Ashley Irvin
• Brittany Jackson, LSW
• Nakisha Jackson
• Kacey James
• Janet R N Kail DPM
• Samantha Jeckering
• Renee J Jennings, LISW
• Amy Jernigan

• Clinical Psychologist in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.