Jacob Donnelly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

63900 Issued in CA

Practice address

1060 Howard St
San Francisco, CA 94103-2820

Phone

(415) 252-4787

NPI assigned

Nov 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

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.

• Jacob Donnelly, Licensed Clinical Social Worker, Inc.

  • Clinical Social Worker
  • Berkeley, CA
  • NPI 1336849546
  NPD Authorized official

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1952581183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 TELEGRAPH AVE STE C",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052072",
            "telephone_number": "510-982-6836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 HOWARD ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941032820",
            "telephone_number": "415-252-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "JACOB",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW 27563",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "63900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lana Dongses, PHARMD
• Eva Gloria Donjacour, ASW
• Eddie Donnellan
• Ann M Donnelly, D.D.S.
• Diane Elizabeth Donnelly, PH.D.
• Sean Donnelly, DPT
• Lindsay M Donofrio
• Michael Donofrio
• Elizabeth Donoghue, LMFT
• Erin Donohoe, MB BCH BAO

• Clinical Social Worker in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.