Individual
MS. ELLEN MARIE JACOB
Active
Individual
MS. ELLEN MARIE JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CDP
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
ISW18102
FL
1041C0700X
Clinical Social Worker
089.013646161TELE
VT
1041C0700X
Clinical Social Worker
1881606
ID
1041C0700X
Clinical Social Worker
Primary
24099
FL
Other
Enumeration date
10/09/2023
Last updated
05/28/2026
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