Ellen Petak Jacowitz I, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

44SC05549100 Issued in NJ

Practice address

452 Old Hook Rd
Emerson, NJ 07630-1381

Phone

(646) 335-2221

NPI assigned

May 16, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Centra Medical Group, LLC

  • Family Medicine Physician
  • Lynchburg, VA
  • NPI 1649228966
  NPD (past)

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510876800000",
    "number": "1629489216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 OLD HOOK RD",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301381",
            "telephone_number": "646-335-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 OLD HOOK RD",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301381",
            "telephone_number": "646-335-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETAK JACOWITZ",
        "first_name": "ELLEN",
        "name_prefix": "Ms.",
        "name_suffix": "I",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-16",
        "last_updated": "2017-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "44SC05549100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pascack Valley Dental Practice
• Anil Patel, MD
• Mona Patel, MD
• Sruti Patel, M.D.
• Patricia Lopinto Apn-C LLC
• Lia Petrocelli, PHARMD
• Dayna Phillips, M.D.
• Robert H Pittman, MD
• Premier Medical Alliance LLC
• Brittany Anne Prisco, MS CCC-SLP

• Mental Health Counselor in Emerson, NJ
• Providers in Emerson, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.