Provider Demographics
NPI:1124779582
Name:MARKOVITS, JAKOB (ASW, MSW)
Entity type:Individual
Prefix:
First Name:JAKOB
Middle Name:
Last Name:MARKOVITS
Suffix:
Gender:M
Credentials:ASW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5163
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-5163
Mailing Address - Country:US
Mailing Address - Phone:914-806-6782
Mailing Address - Fax:
Practice Address - Street 1:669 W 34TH ST STE 102L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-4820
Practice Address - Country:US
Practice Address - Phone:866-354-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108710104100000X, 101YM0800X, 104100000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty