Jennifer Lisa Bluth, PH,D, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW5358 Issued in FL

Practice address

921 Corkwood St
Hollywood, FL 33019-4877

Phone

(954) 665-6272

NPI assigned

Jan 21, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1023526324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 CORKWOOD ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330194877",
            "telephone_number": "954-665-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 CORKWOOD ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330194877",
            "telephone_number": "954-665-6272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3613 Pomerol Dr Apt 307",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "FL",
            "postal_code": "334149425",
            "country_code": "US",
            "telephone_number": "954-303-4336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUTH",
        "first_name": "JENNIFER",
        "middle_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "PH,D, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW5358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle Bodner

• Clinical Social Worker in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.