Individual
ELLEN MARIE JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CDP
Contact information
Practice address
302 FALLS OF VENICE CIR, VENICE, FL 34292-3979
(904) 607-0160
Mailing address
11541 SHADY ACRES PATH, VENICE, FL 34293-8140
(904) 607-0160
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
04/28/2026
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