Active NPI
Marta Rosa Jacobs, PSY D
- Clinical Neuropsychologist
- Weston, FL
National Provider Identifier
1861664302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PY6624
- Practice address
- 1599 Passion Vine Cir
Weston, FL 33326-3659 - Phone
- (305) 336-9714
- NPI assigned
- Mar 25, 2008
- 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PY6624 | FL | Primary |
Addresses
Primary practice location
1599 Passion Vine Cir
Weston, FL 33326-3659
Mailing address
1599 Passion Vine Cir
Weston, FL 33326-3659
Phone (305) 336-9714
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY6624 | FL | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206403200000",
"number": "1861664302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1599 PASSION VINE CIR",
"city": "WESTON",
"state": "FL",
"postal_code": "333263659",
"telephone_number": "305-336-9714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1599 PASSION VINE CIR",
"city": "WESTON",
"state": "FL",
"postal_code": "333263659",
"telephone_number": "305-336-9714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "MARTA",
"middle_name": "ROSA",
"name_prefix": "Dr.",
"credential": "PSY D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-25",
"last_updated": "2008-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "FL",
"license": "PY6624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Weston, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.