Individual provider Active NPI

Jacob Andrew Marciel, LCSW

  • Clinical Social Worker
  • Santa Cruz, CA
National Provider Identifier
1174831044
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
73566 Issued in CA
Practice address
380 Encinal St Ste 200
Santa Cruz, CA 95060-2178
Phone
(831) 469-1700
Fax
(831) 425-1905
NPI assigned
Sep 14, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 73566 CA Primary
Clinical Social Worker 1041C0700X ASW34446 CA
Social Worker 104100000X CA

Addresses

Primary practice location

380 Encinal St Ste 200
Santa Cruz, CA 95060-2178

Mailing address

380 Encinal St Ste 200
Santa Cruz, CA 95060-2178
Phone (831) 469-1700

Other identifiers 1

IdentifierTypeStateIssuer
73566OtherCABOARD OF BEHAVIORAL SCIENCES (BBS)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260406002478 CA Practitioner - Clinical Social Worker 0143795369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5820 Owens Dr
Pleasanton, CA 94588-3900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW34446CAMDClinical Social Worker
73566CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dos Arboles Psychological Services Social Worker Current Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1174831044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 ENCINAL ST STE 200",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602178",
            "telephone_number": "831-469-1700",
            "fax_number": "831-425-1905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 ENCINAL ST STE 200",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602178",
            "telephone_number": "831-469-1700",
            "fax_number": "831-425-1905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCIEL",
        "first_name": "JACOB",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-14",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "73566",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW34446",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF BEHAVIORAL SCIENCES (BBS)",
            "identifier": "73566",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.