Active NPI
Jill Berger Jacobson
- School Psychologist
- College Park, MD
National Provider Identifier
1780274977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 3208 Benjamin Building
College Park, MD 20742-1108 - Phone
- (301) 405-0687
- NPI assigned
- Jan 21, 2021
- Last updated
- Jan 21, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | NU | Primary |
Addresses
Primary practice location
3208 Benjamin Building
College Park, MD 20742-1108
Mailing address
12729 Lincolnshire Dr
Potomac, MD 20854-2364
Phone (757) 621-5621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 7, 2025 through Jul 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05485 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1780274977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12729 LINCOLNSHIRE DR",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208542364",
"telephone_number": "757-621-5621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3208 BENJAMIN BUILDING",
"city": "COLLEGE PARK",
"state": "MD",
"postal_code": "207421108",
"telephone_number": "301-405-0687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "JILL",
"middle_name": "BERGER",
"name_prefix": "Prof.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-21",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.