Kian Fay Jacobs, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

006388 Issued in CT

Practice address

17 Juniper Dr
Ormond Beach, FL 32176-2405

Phone

(860) 817-3175

Fax

(386) 236-9000

NPI assigned

Apr 20, 2007

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

Enrolled in CT, FL, NH3 enrollments

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 3

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

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.

• Lifeworks Counseling Associates PLLC

  • Social Worker
  • Laconia, NH
  • NPI 1144889130

  Clinical, FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1992923635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 TIMBERLINE TRAIL",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321744925",
            "telephone_number": "860-817-3175",
            "fax_number": "386-281-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 JUNIPER DR",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321762405",
            "telephone_number": "860-817-3175",
            "fax_number": "386-236-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Aborn Private Rd",
            "address_purpose": "LOCATION",
            "city": "Ellington",
            "state": "CT",
            "postal_code": "060293120",
            "country_code": "US",
            "telephone_number": "860-817-3175",
            "fax_number": "386-281-5091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "KIAN",
        "middle_name": "FAY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard A Jablonski, DO
• Patti Jean Jacke, M.A.
• Jackson Reef
• Paul William Jackson, PHARMD
• Jacksonville Spine Center PA
• Erika Leigh Jacumin, PA
• Jaideep Hoskote MD PA
• Christopher Colon Jaime, DPT,PT
• Natasha Jairam, MD
• James E McDonnell MD PLC

• Clinical Social Worker in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.