Active NPI
Marilyn Jacob, MA MSW LCSW PHD
- Clinical Social Worker
- Philadelphia, PA
National Provider Identifier
1265587380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CW013424
- Practice address
- 8220 Castor Ave
Philadelphia, PA 19152-2729 - Phone
- (215) 728-4609
- Fax
- (215) 722-4213
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CW013424 | PA | Primary |
Addresses
Primary practice location
8220 Castor Ave
Philadelphia, PA 19152-2729
Mailing address
37 Red Ridge Rd
Levittown, PA 19056
Phone (215) 269-8285
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1000008810825 | Medicaid | PA | |
| 1000008810009 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CW013424 | PA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coordinated Behavioral Care Ipa Inc | Past | Accepting new patients | |
| Jewish Board for Family and Children Services | Past | 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.
-
- Multi-Specialty Clinic/Center
- Bronx, NY
- NPI 1457881443
-
- Community/Behavioral Health Agency
- Brooklyn, NY
- NPI 1366685430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199059200000",
"number": "1265587380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 RED RIDGE RD",
"city": "LEVITTOWN",
"state": "PA",
"postal_code": "19056",
"telephone_number": "215-269-8285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 CASTOR AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191522729",
"telephone_number": "215-728-4609",
"fax_number": "215-722-4213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "MARILYN",
"name_prefix": "Ms.",
"credential": "MA MSW LCSW PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-25",
"last_updated": "2007-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "CW013424",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000008810825",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000008810009",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.