Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Nicholls, LCSW

Individual provider Clinical Social Worker · NPI 1134907942

Jacob Nicholls, LCSW is a Clinical Social Worker in Southbury, Connecticut. Qualified in 2020, 6 years ago. Practices with Southbury Adolescent and Young Adult Counseling Center, a 15-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Connecticut.

Years since qualifying
6
Licensed in
CT
In the registry since
2023
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

519 Heritage Rd Ste 2A5
Southbury, CT 06488-6694
Phone: (203) 568-5923
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 13366 (CT)

Record details

NPI number1134907942
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedSeptember 21, 2023
Last updated in NPPESSeptember 21, 2023
Certification dateSeptember 21, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Southbury Adolescent And Young Adult Counseling Center — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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