Active NPI
Susan Lynn Jacobs, BCBA
- Family Psychologist
- Dover, DE
National Provider Identifier
1467596106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Psychologist
- Practice address
- 1012 College Rd Ste 103
Dover, DE 19904-6506 - Phone
- (484) 681-2170
- NPI assigned
- Feb 16, 2007
- Last updated
- Jun 21, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Psychologist | 103TF0000X | NU | Primary | |
| Behavior Analyst | 103K00000X | 1-18-30404 | DE |
Addresses
Primary practice location
1012 College Rd Ste 103
Dover, DE 19904-6506
Mailing address
583 Shoemaker Rd Ste 230
King of Prussia, PA 19406-4238
Phone (484) 681-2170
Other practice location 1
219 Old North Road
Camden, DE 19934
Phone (302) 697-2173
Other practice location 2
100 Enterprise Pl Ste 100
Dover, DE 19904-8202
Phone (302) 678-3353
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Delaware | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Caesar Rodney School District
- Local Education Agency (LEA)
- Camden, DE
- NPI 1376687087
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687305600000",
"number": "1467596106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "583 SHOEMAKER RD STE 230",
"city": "KING OF PRUSSIA",
"state": "PA",
"postal_code": "194064238",
"telephone_number": "484-681-2170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 COLLEGE RD STE 103",
"city": "DOVER",
"state": "DE",
"postal_code": "199046506",
"telephone_number": "484-681-2170"
}
],
"practiceLocations": [
{
"address_1": "219 Old North Road",
"address_purpose": "LOCATION",
"city": "CAMDEN",
"state": "DE",
"postal_code": "19934",
"country_code": "US",
"telephone_number": "302-697-2173",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 Enterprise Pl Ste 100",
"address_purpose": "LOCATION",
"city": "Dover",
"state": "DE",
"postal_code": "199048202",
"country_code": "US",
"telephone_number": "302-678-3353",
"fax_number": "302-678-9245",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBS",
"first_name": "SUSAN",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "DE",
"license": "1-18-30404",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.