Healthcare Provider Details

I. General information

NPI: 1124779582
Provider Name (Legal Business Name): JAKOB MARKOVITS LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 W 34TH ST STE 102L
LOS ANGELES CA
90089-4820
US

IV. Provider business mailing address

PO BOX 5163
SHERMAN OAKS CA
91413-5163
US

V. Phone/Fax

Practice location:
  • Phone: 866-354-8777
  • Fax:
Mailing address:
  • Phone: 914-806-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138362
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: