Active NPI
Evelyn Ann Jacobson, LMFT
- Marriage & Family Therapist
- Hermosa Beach, CA
National Provider Identifier
1386113603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 117125
- Practice address
- 2200 Pacific Coast Hwy Ste 215
Hermosa Beach, CA 90254-2701 - Phone
- (310) 701-9541
- Fax
- (310) 481-7170
- NPI assigned
- Nov 15, 2018
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 117125 | CA | Primary |
Addresses
Primary practice location
2200 Pacific Coast Hwy Ste 215
Hermosa Beach, CA 90254-2701
Mailing address
2200 Pacific Coast Hwy Ste 215
Hermosa Beach, CA 90254-2701
Phone (310) 701-9541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117125 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587686400000",
"number": "1386113603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 PACIFIC COAST HWY STE 215",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902542701",
"telephone_number": "310-701-9541",
"fax_number": "310-481-7170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 PACIFIC COAST HWY STE 215",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902542701",
"telephone_number": "310-701-9541",
"fax_number": "310-481-7170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "EVELYN",
"middle_name": "ANN",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-15",
"last_updated": "2020-04-24",
"certification_date": "2020-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "117125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermosa Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.