Jacqueline Smith, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

101515 Issued in CA

Practice address

238 Boyce St
Santa Rosa, CA 95401-5426

Phone

(170) 733-8319

NPI assigned

Aug 17, 2021

Last updated

Aug 17, 2021By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jacqueline.smith@stjoe.org

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

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846
  Medicare reassignment

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1700552130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 BOYCE ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015426",
            "telephone_number": "170-733-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 BOYCE ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015426",
            "telephone_number": "170-733-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACQUELINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "101515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jacqueline.smith@stjoe.org",
            "affiliation": "N",
            "endpointDescription": "Jacqueline.smith@stjoe.org",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jacqueline.smith@stjoe.org",
            "address_1": "238 Boyce St",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954015426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Decker Wood Smith
• Douglas Kent Smith, PH.D.
• Elizabeth Ashley Smith, OTR/L, C/NDT
• Elizabeth Jane Smith, MA
• Elizabeth Pointer Smith, CNM
• Jayson Smith
• Jean E. Smith, MD
• Jeffrey K Smith
• Joel Smith, M.D.
• Jordyn Alexis Smith, NP

• Mental Health Counselor in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.