Provider Demographics
NPI:1730388737
Name:JACOBSON, SUSAN BOGEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BOGEN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 BELLA VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-7689
Mailing Address - Country:US
Mailing Address - Phone:561-609-5495
Mailing Address - Fax:
Practice Address - Street 1:2541 BELLA VISTA CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-7689
Practice Address - Country:US
Practice Address - Phone:561-609-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0003657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health