Provider Demographics
NPI:1871923862
Name:JACOBS, BROOKE (MSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 SW EASTBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2430
Mailing Address - Country:US
Mailing Address - Phone:754-281-8789
Mailing Address - Fax:
Practice Address - Street 1:9822 SW EASTBROOK CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2430
Practice Address - Country:US
Practice Address - Phone:754-281-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical