Ellen Marie Jacob, LCSW, CDP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24099 Issued in FL

Practice address

302 Falls of Venice Cir
Venice, FL 34292-3979

Phone

(904) 607-0160

NPI assigned

Oct 9, 2023

Last updated

May 28, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Ellen Long Former name

Medicare fee-for-service enrollment

Enrolled in VT, FL, ID3 enrollments

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 3

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  ID, VT

  Medicare reassignment

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779926400000",
    "number": "1285415059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11541 SHADY ACRES PATH",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342938140",
            "telephone_number": "904-607-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 FALLS OF VENICE CIR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342923979",
            "telephone_number": "904-607-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "ELLEN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW, CDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "24099",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "1881606",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.013646161TELE",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "LONG",
            "credential": "LCSW,  CDP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• J & J Will-Care, Inc.
• Jacaranda Family Medicine P a
• Jacaranda Pointe Anesthesia PL
• Mark A Jackson, LCSW
• Peggy Jackson, ARNP-BC, NP-C
• Tara Elizabeth Jacobson, BS
• Jacqueline Z Fay OD PA
• Barbara B. Jaehne, AU.D.
• James D Shortt MD PA
• James J Gulick DC PA

• Clinical Social Worker in Venice, FL
• Providers in Venice, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.