Active NPI
Kelsey Jacoby, LMSW
- Social Worker
- Brooklyn, NY
National Provider Identifier
1528431863
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Sep 20, 2018.
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 096025-1
- Practice address
- 66 Boerum PL
Brooklyn, NY 11201-5705 - Phone
- (718) 522-6011
- NPI assigned
- Nov 9, 2015
- Last updated
- Nov 9, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 096025-1 | NY | Primary |
Addresses
Primary practice location
66 Boerum PL
Brooklyn, NY 11201-5705
Mailing address
66 Boerum PL
Brooklyn, NY 11201-5705
Phone (718) 522-6011
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096025-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447027200000",
"number": "1528431863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 BOERUM PL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112015705",
"telephone_number": "718-522-6011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 BOERUM PL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112015705",
"telephone_number": "718-522-6011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBY",
"first_name": "KELSEY",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-09",
"last_updated": "2015-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "096025-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.