Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS600 | ME |
N | 103T00000X | Psychologist | PS600 | ME |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS600 | ME |
N | 103G00000X | Clinical Psychologist | PS600 | ME |
N | 103TC0700X | Clinical Psychologist | PS600 | ME |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS600 | ME |
N | 103TF0200X | Forensic Psychologist | PS600 | ME |
N | 103TR0400X | Rehabilitation Psychologist | PS600 | ME |
NPI | 1588713978 |
---|---|
Provider Name | Dr. James Leland Jacobs |
First Address | Vassalboro, ME 04989-4305 |
Second Address | Vassalboro, ME 04989-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 11/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143490000 | (05) | ME |