Individual provider Active NPI

Jane P. Jacobus, PH.D.

  • Clinical Psychologist
  • Bridgewater, NJ
National Provider Identifier
1912068602
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3031 Issued in NJ
Practice address
250 State Route 28
Suite 206
Bridgewater, NJ 08807-1979
Phone
(908) 534-1233
NPI assigned
Dec 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3031 NJ Primary

Addresses

Primary practice location

250 State Route 28
Suite 206
Bridgewater, NJ 08807-1979

Mailing address

315 Mountain Rd
Lebanon, NJ 08833-5030
Phone (908) 534-1233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20050525000107 NJ Practitioner - Clinical Psychologist 4981646452 Practice locations: Bridgewater, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

250 State Route 28 206
Bridgewater, NJ 08807-1979
Phone (908) 534-1233

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3031NJMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346112000000",
    "number": "1912068602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MOUNTAIN RD",
            "city": "LEBANON",
            "state": "NJ",
            "postal_code": "088335030",
            "telephone_number": "908-534-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 STATE ROUTE 28",
            "address_2": "SUITE 206",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088071979",
            "telephone_number": "908-534-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBUS",
        "first_name": "JANE",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2012-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "3031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgewater, NJ

Sources for this page

Verify at the official NPI Registry.