Provider Demographics
NPI:1487898599
Name:JACOBS, ROBIN ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ANNE
Last Name:JACOBS
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 1:1800 FAIRBURN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5959
Mailing Address - Country:US
Mailing Address - Phone:310-213-7893
Mailing Address - Fax:310-275-6914
Practice Address - Street 1:1800 FAIRBURN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5959
Practice Address - Country:US
Practice Address - Phone:310-213-7893
Practice Address - Fax:310-275-6914
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS20041102L00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst