Jacob Mergendoller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

276 5TH Ave RM 604
New York, NY 10001-4527

Phone

(415) 686-1385

NPI assigned

Sep 9, 2020

Sex

Male

Sole proprietor

No

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Fifth Avenue Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • New York, NY
  • NPI 1801037270
  Medicare reassignment NPD
• Light Line Therapy LCSW, PLLC

  • Clinical Social Worker
  • New York, NY
  • NPI 1992644223
  NPD Authorized official

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1962017715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 5TH AVE RM 604",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014527",
            "telephone_number": "415-686-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 5TH AVE RM 604",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014527",
            "telephone_number": "415-686-1385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERGENDOLLER",
        "first_name": "JACOB",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-09",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neyri Nicole Meregildo, MS
• Stacey J. Merel, L.C.S.W.
• Frank Albert Merenda, MA
• Irene Merette
• Michelle C Merew, RN
• Andrew Jarrett Mergl, M.D.
• Mark J Mergler, DDS
• Georgia Marie Mergner, PA-C, MS
• Konstantin Mergold
• Merhi Medicine PLLC

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.