Provider Demographics
NPI:1174114664
Name:JAACOBI, MARISSA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:NICOLE
Last Name:JAACOBI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 S FEDERAL HWY APT E
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8811
Mailing Address - Country:US
Mailing Address - Phone:561-212-3418
Mailing Address - Fax:
Practice Address - Street 1:3319 S FEDERAL HWY APT E
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-8811
Practice Address - Country:US
Practice Address - Phone:561-212-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW222311041C0700X
NY0901171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical