Provider Demographics
NPI:1730441098
Name:JACOBOVITCH, RECHAMA (MS SPED)
Entity type:Individual
Prefix:
First Name:RECHAMA
Middle Name:
Last Name:JACOBOVITCH
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:RECHAMA
Other - Middle Name:
Other - Last Name:JACOBOVITCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS SPED
Mailing Address - Street 1:387 GOLFVIEW LN STE 150
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-4428
Mailing Address - Country:US
Mailing Address - Phone:848-525-3607
Mailing Address - Fax:
Practice Address - Street 1:387 GOLFVIEW LN STE 150
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-4428
Practice Address - Country:US
Practice Address - Phone:848-525-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1925769174400000X
1-12-11565103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist