Provider Demographics
NPI:1730820978
Name:JACOBSON, EMMA ARIELLE (LMHC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ARIELLE
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 1:4521 NE 21ST AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4755
Mailing Address - Country:US
Mailing Address - Phone:561-400-1057
Mailing Address - Fax:
Practice Address - Street 1:4521 NE 21ST AVE APT 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4755
Practice Address - Country:US
Practice Address - Phone:561-400-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health