Jacqueline Sara Mollitor, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

75502 Issued in CA

Practice address

22245 Main St
Ste 200
Hayward, CA 94541-4028

Phone

(510) 600-5139

Fax

(510) 727-9405

NPI assigned

Aug 6, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1457542441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22245 MAIN ST",
            "address_2": "STE 200",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945414028",
            "telephone_number": "510-600-5139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22245 MAIN ST",
            "address_2": "STE 200",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945414028",
            "telephone_number": "510-600-5139",
            "fax_number": "510-727-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLITOR",
        "first_name": "JACQUELINE",
        "middle_name": "SARA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "30348",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "75502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Norisha Ferin Mohammed
• Smita Krishna Mohan, M.D.
• Seana Coleen Mohr, CADC-I
• Jaya S. Mokkapati, MD
• Jamie N Molina-Gomez
• Violet Momanyi
• Edith Moncada
• Mones John Mohseni
• Mones John Mohseni and Mina Mohseni
• Alia Monges

• Clinical Social Worker in Hayward, CA
• Providers in Hayward, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; 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.