Individual provider Active NPI

Jacqueline Nicole Refo, LCSW

  • Clinical Social Worker
  • San Jose, CA
National Provider Identifier
1104253442
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
79426 Issued in CA
Practice address
232 E Gish Rd
San Jose, CA 95112-4706
Phone
(408) 453-7616
NPI assigned
Oct 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 79426 CA Primary

Addresses

Primary practice location

232 E Gish Rd
San Jose, CA 95112-4706

Mailing address

232 E Gish Rd
San Jose, CA 95112-4706
Phone (408) 453-7616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
79426CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1104253442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 E GISH RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951124706",
            "telephone_number": "408-453-7616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 E GISH RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951124706",
            "telephone_number": "408-453-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REFO",
        "first_name": "JACQUELINE",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-01",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "79426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; 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.