Individual provider Active NPI

Kim Elizabeth Bozart, LCSW

  • Clinical Social Worker
  • San Diego, CA
National Provider Identifier
1851403299
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW 25300 Issued in CA
Practice address
1401 Broadway
San Diego, CA 92101-5710
Phone
(619) 276-8112
Fax
(619) 276-8230
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 25300 CA
Clinical Social Worker 1041C0700X LCSW 25300 CA Primary

Addresses

Primary practice location

1401 Broadway
San Diego, CA 92101-5710

Mailing address

PO Box 421141
San Diego, CA 92142-1141
Phone (619) 276-8112

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
LCSW 25300CAMDClinical Social Worker
25300CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
P.E.R.T Incorporated Past Accepting new patients
Community Research Foundation Inc PastSince Mar 17, 2024 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1851403299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421141",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921421141",
            "telephone_number": "619-276-8112",
            "fax_number": "619-276-8230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 BROADWAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015710",
            "telephone_number": "619-276-8112",
            "fax_number": "619-276-8230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOZART",
        "first_name": "KIM",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "25300",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW 25300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.