Clarissa Boberg, LCSW, LSCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2022004932 Issued in MO

Practice address

2401 Gillham Road
Attn: Provider Enrollment Department
Kansas City, MO 64108-4619

Phone

(816) 701-5200

Fax

(816) 302-9939

NPI assigned

Jul 28, 2017

Sex

Female

Sole proprietor

No

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rediscover

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lees Summit, MO
  • NPI 1841235298
  Medicare reassignment NPD
• The Children'S Mercy Hospital

  • Pediatrics Physician
  • Kansas City, MO
  • NPI 1851437719
  Medicare reassignment NPD
• Rediscover

  • Methadone Clinic
  • Kansas City, MO
  • NPI 1659749414
  NPD
• The Children'S Mercy Hospital

  • Mail Order Pharmacy
  • Riverside, MO
  • NPI 1235923194
  NPD
• Guzman Baker LLC

  • Clinical Social Worker
  • Kansas City, MO
  • NPI 1669265328
  NPD (past)

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1124542527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 NE RICE RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865849",
            "telephone_number": "816-347-3069",
            "fax_number": "816-347-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 GILLHAM ROAD",
            "address_2": "ATTN: PROVIDER ENROLLMENT DEPARTMENT",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641084619",
            "telephone_number": "816-701-5200",
            "fax_number": "816-302-9939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7001 Blue Ridge Blvd",
            "address_purpose": "LOCATION",
            "city": "Raytown",
            "state": "MO",
            "postal_code": "641335629",
            "country_code": "US",
            "telephone_number": "816-966-0900",
            "fax_number": "816-347-3200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4805 W 67th St",
            "address_purpose": "LOCATION",
            "city": "Prairie Village",
            "state": "KS",
            "postal_code": "662081434",
            "country_code": "US",
            "telephone_number": "913-432-5454",
            "fax_number": "913-273-0588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBERG",
        "first_name": "CLARISSA",
        "credential": "LCSW, LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-28",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2022004932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Blyth
• Jacquelyn E Boan, FNP
• Stephany Boan
• Mora Boatman
• Jenna Degennaro Bob, APRN
• Katrina Bocanegra, LPC, LCPC
• Karna Inga Bock, CPNP
• Michael Bock
• Bethany Bockelman
• Mel Eugene Bockelman Jr., L.C.S.W.

• Clinical Social Worker in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.