Jonathan Lebolt, PHD, LCSW, CGP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

20618 Issued in MD

Practice address

38 Cerone CT
West Orange, NJ 07052-4113

Phone

(973) 524-4917

NPI assigned

May 25, 2006

Last updated

Dec 14, 2022By the provider in NPPES

Sex

Male

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

Opted out of Medicare

Yes, effective Apr 1, 2026 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Virginia Family Psychiatry PC

  • Cognitive & Behavioral Psychologist
  • Petersburg, VA
  • NPI 1477512416
  NPD (past)
• T Med Behavioral Inc

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1497719272
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1639125446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 CERONE CT",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524113",
            "telephone_number": "973-524-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 CERONE CT",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524113",
            "telephone_number": "973-524-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBOLT",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW, CGP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "20618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Lazarus, P.A.
• Meghan Leach, CCC-SLP
• Sara Leach, PT, DPT
• Leah Melamed Inc
• Kelly Leal
• Noah David Lebovitz, DDS
• Carmen H Lebron, MD
• Daniel Kilho Lee, M.D.
• Garland Lee, PA
• James M Lee Sr., MD

• Clinical Social Worker in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.