Jacqueline Jean Pack
NPI 1528954120ActiveIndividual· Social Worker· Mount Vernon, OH
Social Worker with Revive Behavioral Health, LLC, practicing in Mount Vernon, Ohio. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1528954120 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Jun 18, 2025 |
| Last updated in NPPES | Jun 18, 2025 |
| Certified by provider | Jun 18, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker Primary | 104100000X | S.1302386 | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (OH) |
|---|
Education and affiliations
| Graduation year | 2012 |
|---|---|
| Medicare specialty | Clinical Social Worker |
Medical group
- Revive Behavioral Health, LLCMount Vernon, OH · 4 clinicians
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All 38 social workers in Mount Vernon · All social workers in Ohio