Jacqueline Ellis, LCSW-C – Clinical Social Worker

Key facts

NPI: 1003574229
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 28071 (MD)
Practice address: 5144 Doubs Rd
Adamstown, MD 21710-8919
Phone: (240) 397-4356
NPI assigned: Dec 5, 2021
Sex: Female
Sole proprietor: No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Backpack Medical Group, P.C. Clinical Social Worker · Elkridge, MD · NPI 1851177570

Medicare reassignment NPD MD · SOCIAL WORKER · VA
Gateway to Growth LLC Clinical Social Worker · Adamstown, MD · NPI 1215746318

NPD Authorized official CLINICAL
Linnel Inc Psychiatric/Mental Health Nurse Practitioner · Elkridge, MD · NPI 1932795044

NPD (past) MENTAL HEALTH

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in MD, VA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20240926004542	MD	Practitioner - Clinical Social Worker	1951832278	Reassigns benefits to 1 organization
I20241025000155	VA	Practitioner - Clinical Social Worker	1951832278	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
28071	MD	MD	Mental Health Counselor
0904017476	VA	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Gateway to Growth LLC	Clinical	Current since Jan 5, 2025	Accepting new patients
Backpack Medical Group, P.C.	Social Worker	Current since Jul 15, 2024	Accepting new patients
Linnel Inc	Mental Health	Past since Sep 5, 2023	Accepting new patients

Locations

1453 N Rolling Rd
Catonsville, MD 21228
Phone (410) 455-5461

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	28071	MD
Clinical Social Worker	1041C0700X	28071	MD	Yes
Clinical Social Worker	1041C0700X	0904017476	VA

Addresses

Primary practice location

5144 Doubs Rd
Adamstown, MD 21710-8919

Mailing address

5144 Doubs Rd
Adamstown, MD 21710-8919
Phone (240) 397-4356

Other names

Jacqueline Mitchell Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 6, 2026.

{
    "created_epoch": "1638662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1003574229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5144 DOUBS RD",
            "city": "ADAMSTOWN",
            "state": "MD",
            "postal_code": "217108919",
            "telephone_number": "240-397-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5144 DOUBS RD",
            "city": "ADAMSTOWN",
            "state": "MD",
            "postal_code": "217108919",
            "telephone_number": "240-397-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JACQUELINE",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-05",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "28071",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "28071",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904017476",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "MITCHELL",
            "credential": "LCSW-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Adamstown, MD

All providers in Adamstown, MD · Clinical Social Worker in Maryland

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.