Active NPI
Eliza Jacob-Dolan, LICSW
- Clinical Social Worker
- Jamaica Plain, MA
National Provider Identifier
1295945236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2024704
- Practice address
- 31 Heath St
Jamaica Plain, MA 02130-1650 - Phone
- (617) 523-6400
- Fax
- (617) 523-3034
- NPI assigned
- May 22, 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 | 2024704 | MA | Primary |
Addresses
Primary practice location
31 Heath St
Jamaica Plain, MA 02130-1650
Mailing address
64 Eldredge St
Newton, MA 02458-2017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1303414 | Medicaid | MA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024704 | MA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Service Association of Greater Boston | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Jamaica Plain, MA
- NPI 1801916176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314662400000",
"number": "1295945236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "64 ELDREDGE ST",
"city": "NEWTON",
"state": "MA",
"postal_code": "024582017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 HEATH ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021301650",
"telephone_number": "617-523-6400",
"fax_number": "617-523-3034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB-DOLAN",
"first_name": "ELIZA",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2011-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "2024704",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1303414",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.