Lynette Kaye Jacob, LCSW
Individual provider Active NPI Clinical Social Worker · Montross, VA
NPI 1093466476 · NPPES record last updated Apr 6, 2026
Key facts
- NPI
- 1093466476
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904013293 (VA)
- Practice address
- 290 Haulover Cir
Montross, VA 22520-8809 - Phone
- (703) 606-2880
- NPI assigned
- Jan 17, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Mental Health Specialty Group PA
Practice addresses (Care Compare)
Churchville, VA 24421
Phone (323) 205-7088
290 Haulover Cir
Montross, VA 22520-8809
Phone (703) 606-2880
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in 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 |
|---|---|---|---|---|
| I20220816000558 | VA | Practitioner - Clinical Social Worker | 8325421977 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Current |
Accepting new patients | |
| Potomac Family Counseling, LLC | Clinical | Current |
Accepting new patients |
Locations
199 Main St
Warsaw, VA 22572
Phone (703) 606-2880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904013293 | VA | Yes |
Addresses
Primary practice location
290 Haulover Cir
Montross, VA 22520-8809
Mailing address
290 Haulover Cir
Montross, VA 22520-8809
Phone (703) 606-2880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4M9UNF3 | Other | VA | NASW INSURANCE COMPANY, RRG |
Other providers in Montross, VA
- Diane Frazier
- Paula Garner
- Sandra Page Hall
- Tonya T Hanks
- Jerome Adrian Jackson Jr.
- Michelle Baylor Johnson
- Deanna Lavery
- Tammy Lynne Miller
- Montross Volunteer Rescue Squad
- Brittney Worrell Owen
All providers in Montross, VA · Clinical Social Worker in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.