Jacob D Crosby, LISW, LICDC
Individual provider Active NPI Clinical Social Worker · Lorain, OH
NPI 1508306382 · NPPES record last updated May 28, 2025
Key facts
- NPI
- 1508306382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I.2304680-SUPV (OH)
- Practice address
- 6140 S Broadway
Lorain, OH 44053-3821 - Phone
- (440) 233-7232
- Fax
- (440) 233-9070
- NPI assigned
- Feb 28, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2015
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
6140 S Broadway
Lorain, OH 44053-3821
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20260326002464 | OH | Practitioner - Clinical Social Worker | 2466937545 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICDC.162822 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| I.2304680-SUPV | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellefaire JCB | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LICDC.162822 | OH | |
| Clinical Social Worker | 1041C0700X | I.2304680-SUPV | OH | Yes |
Addresses
Primary practice location
6140 S Broadway
Lorain, OH 44053-3821
Mailing address
6140 S Broadway
Lorain, OH 44053-3821
Phone (440) 233-7232
Other providers in Lorain, OH
- Reginald Cremeans
- Stephanie Crespo Alvarez
- Joanna Crockett
- Deandre Crook
- Pamela Elayne Crook
- Mary Jane Croston
- Carol Crow
- Caitlin Lee Crowell
- Elaine M Crumb
- Alyssa Crundwell
All providers in Lorain, OH · Clinical Social Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2025. 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.