Provider Demographics
NPI:1871715219
Name:JACOBS, KAREN G (MSW LCSWC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:G
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 LISA OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4739
Mailing Address - Country:US
Mailing Address - Phone:301-230-5500
Mailing Address - Fax:
Practice Address - Street 1:328 LISA OAKS WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4739
Practice Address - Country:US
Practice Address - Phone:301-230-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD054991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical