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DR. JONATHAN LEBOLT PHD, LCSW, CGP
NPI 1639125446
Social Worker - Clinical in West Orange, NJ

Active since May 25, 2006Opted out of Medicare · through Apr 1, 2028
38 CERONE CT, WEST ORANGE, NJ 07052(973) 524-4917 Get Directions Write a Review

NPPES record last updated: December 14, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 14, 2022, Oct 29, 2019, Nov 19, 2015 (3 updates tracked since 2015).

About Dr. Jonathan Lebolt Phd, Lcsw, Cgp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JONATHAN LEBOLT PHD, LCSW, CGP (NPI 1639125446) is an individual clinical provider in West Orange, New Jersey, licensed in Maryland (20618) and active in the NPI registry since May 2006. He has opted out of Medicare through April 1, 2028.

NPPES Registry Identity

NPI1639125446
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameDR. JONATHAN LEBOLTCredential: PHD, LCSW, CGP
Location Address38 CERONE CTWest Orange, NJ 07052-4113
Mailing Address38 Cerone CtWest Orange, NJ 07052-4113 · (973) 524-4917
Phone(973) 524-4917
Sole ProprietorYes
Enumeration DateMay 25, 2006
Last NPPES UpdateDecember 14, 20223 updates tracked since enumeration
NPPES CertifiedDecember 14, 2022
✔ NPI 1639125446 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MD · 20618
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
38 CERONE CT, West Orange, NJ 07052
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jonathan Lebolt Phd, Lcsw, Cgp has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2026 through April 1, 2028.

Opt-Out Effective DateApril 1, 2026
Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jonathan Lebolt's NPI number?

The NPI number for Jonathan Lebolt is 1639125446. It was assigned to this individual provider in the NPPES registry on May 25, 2006.

Where is Jonathan Lebolt located?

Jonathan Lebolt practices at 38 Cerone Ct, West Orange, NJ 07052. The listed phone number is (973) 524-4917.

What is Jonathan Lebolt's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jonathan Lebolt enrolled in Medicare?

No. Jonathan Lebolt has opted out of Medicare through April 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jonathan Lebolt was last updated on December 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.