Jennifer Childers, MSSA, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1000236-SUPV Issued in OH

Practice address

8445 Munson Rd
Mentor, OH 44060-2410

Phone

(216) 280-0401

NPI assigned

Jul 24, 2010

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": "1279929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1295048809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 W 6TH ST",
            "address_2": "2G",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441131321",
            "telephone_number": "216-280-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8445 MUNSON RD",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440602410",
            "telephone_number": "216-280-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "JENNIFER",
        "name_prefix": "Miss",
        "credential": "MSSA, LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-24",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1000236-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Mentor, OH
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; 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.