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

MS. Ellen Marie Jacob, LCSW, CDP

Individual provider Clinical Social Worker · NPI 1285415059

MS. Ellen Marie Jacob, LCSW, CDP is a Clinical Social Worker in Venice, Florida. Qualified in 2022, 4 years ago. Practices as a sole proprietor. Licensed in Florida, Idaho and Vermont.

Years since qualifying
4
Licensed in
FL, ID, VT
In the registry since
2023
Specialties on file
3
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

302 Falls Of Venice Cir
Venice, FL 34292-3979
Phone: (904) 607-0160
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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 24099 (FL)
Clinical Social Worker Taxonomy 1041C0700X · Licence 1881606 (ID)
Clinical Social Worker Taxonomy 1041C0700X · Licence 089.013646161TELE (VT)

Record details

NPI number1285415059
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW , CDP
Sole proprietorYes
NPI enumeratedOctober 9, 2023
Last updated in NPPESMay 28, 2026
Certification dateMay 28, 2026

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated

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